Medicare Part A Case Study

Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or suffer from kidney failure. Medicare has a basic four-part structure: Part A, which is hospital insurance, Part B, which is supplementary medical insurance, Part C, which is Medicare advantage, and Part D, which is prescription drug coverage. Part A and B make up what is known as traditional Medicare. Part A concerns hospital insurance, this is financed by payroll taxed through employers and employees. Part A pays for a portion of inpatient hospitalization, nursing care, home health care, and hospice. Part A includes a benefit period; this means that the insurer will pay for 60 days in the hospital long as a deductible is paid. If the patient stays longer than that set amount of days, then a copayment begins. Part B is financed by tax revenues and also consists of a premium based on income paid by the individual being insured. Services like the doctor, …show more content…
An insurer with an annual out-of-pocket limit does not have to pay for an individual’s medical expenses once reaching the limit set. This means the one being insured may not be able to afford a procedure that he needs. Let’s use Craig for an example. If Craig has cancer, he may have cancer treatment such as chemotherapy and other procedures that will become expensive quickly. Craig’s doctor believes that this next surgery will remove the malignant cells in his body; however, Craig has reached his annual out-of-pocket limit. This means that if Craig must wait another year or pay for the procedure out of pocket. Although I do not believe that an annual out-of-pocket expense is beneficial, I do recognize that no annual out-of-pocket limit could cause cost-sharing to increase in price. Although increasing the expense of cost-sharing is not seen as beneficial, individuals will never be expected to pay for all of a medical