Medicare and Health Care Payer Solutions

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Humans wish to be fit, healthy, and free of illness, able to work till retirement and enjoy the benefits. However, this is not always the situation in the healthcare industry. As a result, this is where Medicare and Social Security come into play. Payers in the health sector and organizations like Medicare are in charge of determining service rates, accepting payments, handling claims, and paying providers’ claims. Payers are distinct from providers such as clinics and hospitals that offer services (“Payers in the health care industry,” 2020). Generally, Payers are a significant trend in healthcare since they improve treatment effectiveness and quality.

In the United States, Medicare is a government initiative that becomes accessible to elderly individuals when they reach the age of 65. As a result, it will be upon them to make enrollment decisions for things like Original Medicare and Medicare Advantage. The concept of universal health care has been around for decades. However, the majority of people, particularly the elderly, are still unaware of these payer solutions. According to Hernandez et al. (2021), since information about how older adults can obtain Medicare is incredibly limited, it has become challenging to make the appropriate decision. Generally, one should consider whether they want the liberty to get their doctors or frequently travel and if the scheme fits their finances before selecting a Medicare plan.

There are various ways in which people can apply for Medicare. One of the most common approaches is through Social Security. Individuals can get in touch with Social Security in a number of different ways, including online, by phone, or in person. Traditional Medicare can be obtained by completing the Social Security Administration’s online Medicare application. They can apply online by going to the Social Security Administration portal at socialsecurity.gov, where they must create a “MySocialSecurityAccount” if they do not yet have one (Guinan, 2022). Users should select Medicare Enrollment from the homepage and “Apply for Medicare Only.” Generally, the entire process takes a shorter time if a person observes the instructions.

Most seniors prefer to obtain information in person about benefits, plan information, and the cost of healthcare provided. In-person communication is preferable since one can receive the necessary resources to make the Medicare Payer Solution decisions. Individuals can apply by phone at 1-800-772-213 (TTY 1-800-325-0778) or by visiting their local Social Security office (Guinan, 2022). After that, you must select your coverage by visiting Medicare.gov or working with an independent insurance broker. Traditional Medicare only provides essential benefits; however, having coverage through a private insurance company will be an added benefit.

There are many information sources to consider when making Medicare plan decisions. For instance, social networking incorporates insurance agents, governmental advisors, family and friends, and health professionals. The elderly can enroll through a third-party agent or broker. Additionally, seniors can consult with family and friends to make comparisons between the various benefits of Medicare to those of other payers such as Medicaid (Hernandez et al., 2021). Finally, they can learn more about these services using available internet resources that will necessitate using a computer or smart device with internet access and navigating to www.medicare.gov via the internet.

Lastly, an older adult can seek help from a local hospital, where a case manager is assigned to begin acquiring Medicare benefits. A case worker from Adult Protective Services (APS) or any Department of Human Services should team up with the client. They then develop a service plan, which is forwarded to the appropriate healthcare payer once the client has completed all required documentation.