How Medicare changes will affect Americans in 2021 Assignment | Online Homework Help

A research paper is required for this course. The paper must adhere to APA guidelines. The paper will present your research findings and add to the body of knowledge about your specialization. The paper can provide new knowledge, affirm existing knowledge, or refute existing knowledge. The paper should be a minimum of 2,500 words and have at least five peer reviewed research sources. Hypothesis is ” How Medicare changes will affect Americans in 2021

The focus of this paper is to give readers an insight as to how the Medicare program in the United States measures up against similar services offered in other countries around the globe. This paper will also give readers information on how to file a claim with the Medicare program for preauthorized services and will include tables, charts, and graphs as to waiting periods as to when services can or will be rendered.

What is Medicare you may ask. “Original Medicare comes in two parts. Medicare Part A covers hospital services, skilled nursing facility care, hospice, and some home health care. Medicare Part B covers medical services, including doctor visits, preventive screenings, certain vaccinations, lab tests, and durable medical equipment” (https://www.ehealthinsurance.com/medicare/resources/how-does-medicare-work).

In the 1984 fiscal year the federal government in the United States began to pay for Medicare patient costs on the basis of 467 different diagnostic/reimbursement categories. Each year officials decide on the amounts to be reimbursed for each Medicare billable hospital and long-term care admission based on the original diagnosis or condition that was responsible for the patient to be admitted. To date there are over 9,000 diagnosis codes that the Diagnostically Related Group (DRG) has deemed as reimbursable under the Medicare program in the United States.

“In 1960, the United States spent $800 million on nursing home care. By 2007, the United States was spending $131 billion on nursing home care each year.

Nursing Facility Annual Percent

Change from Previous Year

                                                1960                17%

1980                15%

1990                11%

2000                5%

2003                4%

2007                4.8%

Nursing facility costs average annual percent change from previous year have faced constraints as the federal and state governments have attempted to rein in exploding health care costs” (Health, U.S., 2008. Table 127).

“In 1960, the United States spen $1 million on home health care. By 2007, the United States was spending $59 billion on home health care per year, an even more dramatic increase in reate of spending than on Nursing Facility care.

Home Health Average Annual Percent Change

From Previous Year

1960                —–

1970                14%

1980                27%

1990                18%

2000                7%

2003                9.5%

2007                11.3%” (Health, U.S., 2005, p.363).

There are four conditions that a patient has to meet to be eligible for Medicare coverage.

1. Spend 3 consecutive days in a hospital (excluding discharge day).
2. Must be transferred to a nursing facility for treatment of original cause of hospitalization.
3. Patient must be admitted to nursing facility within 14 days of hospital discharge date.
4. A physician must certify that the patient is in need of nursing care and or rehabilitation services that are required on a daily basis.

There are many things that are not covered under the Medicare insurance program. Some of things that are not paid for include:

1. Routine physical and related tests
2. Eyeglasses and eye examinations
3. Hearing examinations or hearing aids
4. Immunizations (will pay for pneumococcal shots only).
5. Routine foot care.
6. Orthopedic shoes or other supportive devices for foot care
7. Custodial care
8. Preventive care, filling, removal, or replacement of teeth.

Currently, the government in the United States is looking to make cuts in 2021 to the Medicare program. If these cuts are passed then there will be restrictions put on supplies, limitations will be placed on reimbursements, and eligibility requirements will be harder to meet. “In 2006, Medicare was paying for 188,976 residents’ care, Medicaid paying for 934,402 residents’ care and Other Payers were paying for the remaining 309,486— a 1,432,864 residents in facilities total receiving Medicare and Medicaid payments (CMS OSCAR Form 672: F75, F78, June 2006).

In 2006 the Medicare program implemented Plan D. Plan D was designed to give those participating in the Medicare program assistance with medication expenses by increasing the amount the program would cover for medications. Over 65 % of those living in the United Sates that are 65 and over taking prescription medications that in 2002 were costing nearly $8,000 annually.

Federal requirements direct long-term care facilities to prominently display somewhere in the facility written information, and provide to residents and those applying for admission to the facility oral and written information about how to apply for and use Medicare and Medicaid benefits. The facility must also provide these individuals and/or their families with information on how to receive refunds for payments that were made for medical care that were covered by the benefits the individual is receiving. Refunds for previous payments refers to refunds due as a result of payments made during retroactive determination periods.

CMS OSCAR Form 672: F75, F78, June 2006