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    Understanding Medicare Coverage

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    1)What portion of the bill would Medicare cover for a participating 69 year old stroke patient who was 1) admitted to an acute facility for 10 days, transferred to a sub-acute rehabilitation facility for 30 days, then discharged to home with a prescription for Visiting Nurse (Home Health) Services 3 times a week for 30 days?
    2)How does Medicare Part D work? In what ways would The Affordable Care Act change the way it works?

    thank you

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    Solution Preview

    Hope this helps you.

    The best resources to find out about Medicare coverage is the Medicare website: www.medicare.gov and new website of the Affordable Health Act: healthcare.gov. On both sites you can find the latest changes or innovations available.

    Your first question relates to coverage for hospital, skilled nurse facility and home health care. These services will be covered under Medicare Part A and Part B. Part A covers costs related to the institution itself and Part B covers the cost of qualified health care practitioners.

    In general, Medicare coverage has 4 parts A, B, C and D. Part A covers "inpatient care in hospitals such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals; inpatient care in a skilled nursing facility,not custodial or long term care; hospice care services; home health care services and inpatient care in a Religious Nonmedical Health Care Institution" (Medicare.gov., n.d., para. 9). Part B covers most of medically-necessary services like doctors' services and other outpatient care (depending on the insurance plan the person chooses). Part C or Medical Advantage Plan is another type of coverage options like HMOs or PPOs that are offered by private insurance. Part D covers prescriptions.

    In reality, Medicare will cover the portion of the bill left after the patient has satisfied his/her part, according to the service provided and Medicare established fee.
    The patient's cost will depend on the state he/she resides as Medicare takes this into consideration for establishing compensatory payments to providers, the type of ...

    Solution Summary

    The solution involves a discussion of Medicare coverage in general and with an specific example of coverage for a stroke patient in an acute and subacute setting plus home health. It also addresses the impact of the Affordable Care Act on Medicare part D.