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Healthcare Utilization Essay

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With the advancing of medical technologies and therapies in the United States, more people are living longer with chronic illness, such as diabetes and heart disease. Access to quality health care and coverage is vital for our patients to maintain a long and healthy lifestyle. A1. Medicare Part A

Generally, Medicare part A covers the cost of services in a hospital and in a skilled nursing facility (SNF). A person is eligible for Medicare part A when they are 65 years old (or under 65 years old and disabled) and receiving or eligible for benefits from Social Security or the Railroad Retirement Board (Centers for Medicare & Medicaid Services , 2012).

As an inpatient in an acute care hospital, inpatient rehab facility (IPR), long-term care hospital (LTCH), critical access hospital, and/or mental health care, part A covers many services. These services includes tests, surgeries, general nursing care, medications, semi-private rooms, meals, and other hospital services and supplies (CMS, 2012). It does not cover private rooms, unless medically necessary, private-duty nursing care, telephone or television, or personal care items, such as toiletries.

The monthly premium for Medicare part A is $0 if the beneficiary paid Medicare taxes while employed. The monthly premium for part A for those who did not pay taxes is $441.00. In addition, the deductible for inpatient hospital stay is $1,184 per benefit period with $0 for the first 60 days of each benefit period (CMS, 2012). Days 61-90 is $296 per day during the benefit period. Days 91 and beyond is $592 per each “lifetime reserve day“, up to 60 days over the person’s lifetime. Medicare part A covers all costs except for a daily coinsurance for each lifetime reserve day (CMS, 2012). To stay in a SNF, the cost for the beneficiary is $0 for the first 20 days of each benefit period, $148 per day for days 21-100 of each benefit period, and all costs for each day after 100 days for each benefit period (CMS, 2012). According to the Medicare website,

“a benefit period begins the day admitted as an inpatient in a hospital or SNF. The benefit period ends when haven't received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods” (CMS, 2012). A2. Medicare Part B


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