The Four, Structure And Structure Of Medicare

1. Briefly describe the Medicare program (who in general is covered/ eligible and the basic structure of the program- the parts & what overall each covers).
Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or individuals with fatal kidney failure. A basic four-part structure is used to construct the foundation of Medicare, Part A: hospital insurance, Part B: supplementary medical insurance, Part C: Medicare advantage, Part D: prescription drug coverage. Part A and B make up what is known as traditional Medicare and Part C is what is known as Medicare Advantage. Part A concerns hospital insurance, this is financed by payroll taxed through employers and employees. Part A pays for a
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Medicare Advantage is Part C of the four-part structure. Medicare Advantage specifically covers hospital insurance, supplementary and prescription drug coverage. As clarification, Medicare Advantage covers all parts of Medicare. A few examples of these are hospitalization, nursing care, ambulances, x-rays and laboratory tests, and medication. An individual with Medicare Advantage pays a premium to Medicare and MCO (Managed Care Organization). For example, Craig picked Medicare Advantage at first because he knew that Medicare Advantage had the three different parts combined into one program. This combination meant that Craig would have a cheaper premium with Medicare Advantage, rather then paying for using Medigap and paying for Part D.

3. Describe one benefit for Craig of choosing a Medicare Advantage plan over traditional Medicare.
Both Medicare Advantage and traditional Medicare have aspects which could benefit Craig. One benefit for Craig of choosing a Medicare Advantage is the cap on out-of-pocket expenses. In the article, Craig found comfort in the Medicare Advantage’s cap of expenses. This means that Craig would never rack up a huge bill that he could never pay for in his life time. This cap of out-of-pocket allows Craig to worry less about using the services Medicare provides. Peace of mind is absolutely a benefit for Craig.

4. Describe one benefit for Craig if
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The reason someone would buy Medigap is so an individual would have less risk, specifically lower the risk of having a huge out-of-pocket expense. A pre-existing condition is medical opinion or a situation that has happened prior to try to enroll in a new insurance plan. In the story, Craig was unable to buy Medigap because of is pre-existing condition. For example, if Craig was diagnosed with cancer prior to when he tried to enroll in traditional Medicare he may be denied acceptance due to his medical problem. Although the medical situation of Craig is unclear, the reader is informed that Craig was denied and this prevented him from being able to transfer from Medical Advantage to traditional Medicare with limited risk. As of a result of Craig’s medical situation, he may be locked out of ever receiving

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