Medicare

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Since 2008, Medicare has refused to reimburse hospitals for the cost of treating patients who suffer avoidable medical complications. Although technically Medicare can actually expel a hospital with high rates of errors from the Medicare program, this is very rarely done.

However, in 2015, the federal government did cut payments to 721 hospitals which possessed documented high rates of infections and other patient injuries in the previous year. Among the 721 institutions were 2 frequently used by patients in Eastern Pennsylvania – the Hospital of the University of Pennsylvania, in Philadelphia, and Geisinger Medical Center in Dansville, Pennsylvania.

Hospital acquired conditions, or HACs, include infections, blood clots, bed sores, and other complications which are considered avoidable. The penalties levied on the 721 hospitals are estimated to be in excess of $300 million. In 2013, approximately 1 in 8 admissions to a hospital included an HAC. Populations at highest risk are the very young and the very old, as well as those who have chronic diseases which would place them at a higher likelihood of developing an HAC.…

Continue Reading Government Cracks Down on Hospitals with High Rates of Complications

For those unsure or unaware, Medicare and Medicaid are both government health insurance programs. However, they are still different programs, and therefore require different eligibility requirements and different coverage. Essentially, Medicare is a government program designed to provide health insurance coverage for the elderly and disabled. On the other hand, Medicaid is a needs program, which means that it exists to cover the healthcare costs for the very low income individuals.

Medicare is a purely federal government program attached to Social Security. It is available to citizens and certain other legal residents at the age of 65, and also covers people who are disabled under the Social Security guidelines. It is a 4-part program which covers hospitalizations through Part A, outpatient and doctors visits through Part B (more about parts A and B), potentially private plans (Medicare Advantage Plans) through Part C, and prescription coverage, through Part D (more about parts C and D).

Medicaid is a joint federal and state program that covers healthcare costs for low income individuals. Additionally, it covers long-term custodial care for poor and elderly individuals. There is a Medicaid program for each state in the U.S., and the federal government funds up to 50% of the costs of each state’s Medicaid program.…

Continue Reading The Key Differences between Medicare and Medicaid

Medicare is often discussed on the news, but very little time is spent explaining how precisely patients can qualify. Medicare Part A covers inpatient hospital stays or care in a skilled nursing facility. Medicare Part B covers outpatient medical care, such as doctor visits. In order to qualify for Medicare Part A and Part B,…

Medicare is now in its third year of testing their “Independent at Home” project, which was created by the Affordable Care Act. This program provides Medicare’s frailest senior citizen patients, who all suffer from multiple chronic conditions, with house calls by healthcare professionals.

These are Medicare’s most expensive type of patient, because they are often…

Immigrants who receive provisional legal status under President Obama’s new executive orders may be eligible for Social Security and Medicare or Medicaid benefits.  Under the President’s plan, U.S. residents can apply for provisional legal status if they have  lived in the U.S. for at least 5 years, can pass a criminal background check and have…

A recent study by researchers at Stanford University and Harvard University has shown that if a private health plan manages to negotiate lower prices with health care providers, they may make up the difference by providing health care to Medicare beneficiaries. The study examined data from more than 300 geographic regions in the U.S., including…

Many older patients, who are on Medicare or in a Medicare Advantage Plan, are shocked when they are hospitalized for less than 3 days only to find out that Medicare will not pay for nursing home coverage following this brief hospitalization.  These patients, who are technically admitted for “observation” for less than 3 full days,…