Medicare Pros And Cons

A.1 Standards

Medicare is health insurance coverage provided by the Federal Government. In order to qualify for Medicare, you must meet certain conditions. A person qualifies if they are 65 years of age and older, a person may qualify if they are under the age of 65 with disabilities or have end stage renal disease that requires dialysis or needing a kidney transplant. Medicare does not cover the cost of all healthcare. (Social Security Administration, 2016, p. 4)

Medicare has four parts A, B, C, and D. Medicare Part A covers inpatient hospitalization, skilled nursing centers, hospice and some home health services. Medicare Part B covers some services not covered by Part A. Typically there is a premium charged for this coverage. Part B Covers medical supplies and outpatient visits. Medicare Part C, also known as Medicare Advantage plans are offered by private insurance companies which are in contract with Medicare. Medicare Part C provides you benefits from Part A, Part B and usually covers prescription drugs. This plan will cover most services. Last is Medicare Part D, Part D is a prescription drug program offered by private insurance companies. Part D allows drug coverage to the original Medicare plan. (Medicare.gov, 2016)

Conditions of Participation was created to ensure all facilities participating in Medicare follow a set of regulations that protect the safety of Medicare recipients. In 1986 revisions were made to reinforce accreditation and certification procedures. Participating hospitals that are accredited by the Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association have been deemed to meeting Conditions of Participation requirements on the wellbeing of Medicare Recipients. The Joint Commission on Accreditation of Healthcare Organizations also requires that the facilities are licensed by their state. (Lohr, 1990, p.