They have the option of choosing Original Medicare or Medicare Advantage Plan. Original Medicare includes part A that covers hospital insurance and part B that covers medical insurance.Your coverage is directly from Medicare. You have your choice of providers as long as they except Medicare. The premiums are usually about 145 dollars or more if your income is higher. There is generally a copay or coinsurance that you have to pay as well. If you want a prescriptiondrug plan, referred to as Medicare part D, you must sign up for it. Original Medicare also gives you the option to get supplemental insurance to cover things like copayments that are not covered under A and B. Medicare Advantage plan includes part A and part B but the coverage is provided via private insurance companies approved by Medicare. You may choose a provider that is part of the plans network and your part B premium is about 145 dollars or higher based on
5SAT TASK 3income. They pay a monthly premium for Advantage plan and part B. They are also required to pay copayments or coinsurance but there is a yearly limit so once they reach that there is no additional out of pocket expenses. If you need prescription drug coverage, it is offered through the Advantage plan. There is not an option for supplemental insurance under the Advantage Plan, but some plans do have lower out of pocket expense (The Official U.S. Government, 2020).A2A. Medication coverageIn Japan, the prices for medications and procedures are negotiated every two years between the government and he providers. The prices are set and the same throughout the country (Reid, 2008). In the U.S., there are many different drug plans depending on your coverage and copays. The insurance company can deny some prescription medications depending on the expense of the drug, your plan coverage or if there is a similar product on the market. The United States has a very large drug corporations that set prices for medication that are often very expensive. Many people will go without medication because their insurance will not cover it and they cannot afford it. Often, plans will deny a brand name medication but pay forthe generic form of it. Access to medication in the United States could be a lot more affordable.A2B. Specialist Referral In Japan, no referral is needed to see a specialist. Anyone can see whomever they choose,whenever they choose. The pricing structure for specialty care is controlled the same as all care in Japan (International Health Care, n.d.). In the United States, access to a specialist depends on the insurance plan. Most HMO’s require a referral from your primary care provider and limits the choices of specialist, while a PPO allows you to have direct access to the specialist and more
6SAT TASK 3choices. Those individuals that do not have insurance or on Medicaid have more difficulty
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- Spring '19
- Universal health care