Topics: Health insurance, Health care, Medicare Pages: 7 (2055 words) Published: April 23, 2014

KOT 734.3.4 Organizational Systems & Quality Leadership


KOT Task 2

April 17, 2014

A1. Medicare Part A

According to (Cherry and Jacob, 2011) Medicare is a federal funded health insurance plan for people over the age of 65 and for those who are younger with certain disabilities. In discussing the details to Mrs. Zwick’s daughter about Medicare coverage information I would explain to them in terms that both mother and daughter can understand. An explanation would begin by letting Mrs. Zwick’s daughter know that Medicare part A is a hospital insurance that helps covers several health care facilities such as hospital stay, skilled nursing facility, hospice services and home health services. Mrs. Zwick was admitted to the hospital as an inpatient for five days for a mild stroke. The inpatient criteria is important information because patients who often go to the hospital are not necessarily admitted but are placed in observation status. The inpatient status must be written by a physician via a doctor’s order. Since Mrs. Zwick was admitted for the five days she met the requirements for Medicare part A coverage and the criteria for skilled nursing facility. Medicare Part A covered the 5 days of inpatient stay at the hospital. The skilled nursing facility requirements are that the patient have a three midnight hospital stay in order to be considered for admission. Since the requirement was met Mrs. Zwick’s Medicare part A covers her first 20 days of skilled nursing and rehabilitation services at 100% with no cost to the patient. Her services in the skilled facility include a semi private room however as skilled/long term care nurse most nursing homes offer a private room for skilled patients with no added charges. Other services include medications, meals, supplies and rehabilitation services that include PT, OT and ST if needed. Mrs. Zwick’s stay was 40 days so the daughter would need to be aware that after the 20 days the patient is responsible for a copayment that is approximately 20% or about 152.00 per day. (Medicare.Gov)

A2. Medicare Part B

Medicare Part B is the medical insurance that covers different types of services compared to Medicare part A. Medicare part B has a deductible that changes annually. Once the deductible is paid each year, Medicare Part B will pay 80% of the approved Medicare services (Medicare.gov). Medicare part B covers two types of services that include medically necessary services such as services or supplies needed to diagnose/treat a medical condition as long as it meets standards of medical practice. For example if Mrs. Zwick fell at her home and broke a hip her Medicare part B benefits would cover her surgical hip repair as long as it is deemed medically necessary. The other service that Medicare part B covers is preventive services. Elderly immune systems are diminished as they age placing them at risk for flu and pneumonia. Mrs. Zwick’s is 77 years old which places her at risk so she would benefit from her Medicare part B preventive services for flu and pneumonia vaccinations. Equipment that is covered by Medicare part B include wheelchair, walkers, bedside commode and splints. Other services include ambulance services, mental health, and limited outpatient prescription drugs. (Medicare.gov)

A3. Medicare Part D

Medicare Part D is prescription drug benefit plan. The plan will cover Mrs. Zwick’s prescriptions that are not covered by her Medicare part A and B. There are several prescription drug plans and each plan has its own formulary. I would explain to the daughter that the plans are placed in different levels and that each level has a different costs. After reviewing the plans and levels the daughter can decide what plan will best fit Mrs. Zwick’s needs. This plan however does come with an out of pocket expense such as a copayment and monthly premium’s...

References: Carroll, S. S., Rodin, D. (December 2010) States in Action Archive
Health Homes for the Chronically Ill: An Opportunity for States http://www.commonwealthfund.org/Newsletters/States-in-Action/2011/Jan/December-2010-January-2011/Feature/Feature.aspx
Holland, K. (2012, October 5) What Medicare does and does not cover? Retrieved from
Medicare Part A. Retrieved April 15, 2014 from Medicare.gov available at
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