KOT Task #2: Medicare Essay

Though Medic ar excogitates are typic wholey for persons over the historic period of 65 years old, they do non engender without represents to the forbearing. If the long-suffering has enough work credits, Medi tending Part A is automatically available to the patient one time he or she reaches age 65. Medi make out Parts B and D, however, require the patient to navigate through an practical application process and the patient may incur penalty fees if he or she does non sign up for the intents during the allotted time frame once they have reached the age of 65. For Medi take parts B and D, the patient is responsible for paid the designated premiums. The Medi help Part B premium ranges from $96.40-110.50 periodic and the Part D scheme ranges from $28.60-$38 monthly. There is also additional Medi boot final causes available for the patient to purchase through insurers such as Blue Cross and Blue guard or Etna, however on that point are additional premiums in change a mounts (Medicare.gov, 2012).In most cases, Medicare Part A will extend yardbird hospital stays, rehabilitation centers, and long-term care facility stays. For Mrs. Zwick, Medicare Part A would apply to the rehab and inpatient hospitalizations. Medicare Part A will cover Mrs. Zwicks five day hospital stay and the first off 20 long time of her stay at the rehabilitation facility. Each day following the first 20 days of rehab, a fee of $144.50 per day will compile at the rehabilitation facility for a total of $2890.00 which the facilities will be responsible for receivable to the patient acquiring a preventable transmittal during her stay (Medicare.gov, 2012). Medicare Part B is similar to medical insurance binding medically necessary services such as MD cut backs and services, outpatient care, permanent medical equipment, home health services, and somemultiplication stoppage care services.In Mrs. Zwicks case, Medicare Part B would cover the prescribed walker or other assis tive devices if needed. However, based on Medicare Part B think reporting, Mrs. Zwick will be responsible for a deductible of 20% of the cost of the walker (Medicare.gov, 2012). Medicare Part D is an elective prescription medicine coverage protrude available to Medicare recipients.There are various prescription dose plans offering medication coverage based on the plans preferred drug list. Though Mrs. Zwicks plan coverage was non specified in the case study, she may be responsible for a co- fall inment for prescription drugs. If Mrs. Zwick does in fact have a co-payment, it would be a set amount for example $10 per prescription or less(prenominal) if she receives generic drugs. Or, depending on if Mrs. Zwick has entered a coverage gap or ring hole, she will then be responsible for 50% of the be of her prescription medications (Medicare.gov, 2012).Though Mrs. Zwick does have Medicare coverage, the plan may not pay for Mrs. Zwicks extended stay or additional care take relat e to a hospital-acquired condition. In recent years, Medicare began refusing to pay for preventable, hospital acquired infections qualification hospitals and other facilities accept responsibility for preventable infections acquired during the patients stay. However, in Mrs. Zwicks instance, there may be some debate as to which facility will be held accountable for the preventable urinary package infection (UTI).Though the case study reads that Mrs. Zwick was diagnosed with a hospital-acquired UTI, it also responsibilitys that she was diagnosed 10 days into her stay at the rehabilitation facility and that there were complaints that Mrs. Zwick was not receiving proper catheter care. If the rehab facility was not following the current evidence-based protocol related to the patients catheter care, there is a strong possibility Mrs.Zwick did not acquire the urinary tract infection until after she was transferred to the rehab facility. Therefore, the hospital would not be responsible for the be of care related to the UTI. However, Medicare would hitherto not cover the costs and the nursing facility would then be held accountable for the extra costs incurred during the patients extended stay.Consolidated carriage Budget Reconciliation Act, also known as COBRA, is a plan available to persons who have a loss of employment and health coverage. The COBRA plan will allow Mr. Davis to continue his health coverage beginning the skipper date his coverage was ceased and is usually available for approximately 18 months. However, the Cobra plan is not free of charge to the unemployed patient. The plan typically offers selfsame(a) plan coverage to the patient however the plan is more costly than the original premium the patient was used to paying. The cost of the COBRA plan is usually the amount of the previous premium in addition to the amount the employer contributed positive a 2% administration fee. The premium amount the patient would be responsible for would be quite a bit more costly, to date still less expensive than an individual rate. In regulate to for the patient to be covered by the COBRA plan, he would have to submit all the proper paperwork within the allotted time frame and pay the monthly premiums without monthly payment reminders (FAQs for Employees closely COBRA Continuation Health Coverage).Though COBRA is a way for Mr. Davis to continue his health insurance coverage once he became unemployed, it is not likely to be affordable. This then becomes a challenge that state or local governments are faced with. Two challenges state or local government may be faced with in providing care for patients like Mr. Davis with pre-existing conditions and lack of insurance coverage are change magnitude costs and decreased health maintenance of the patients. Patients with long-term, chronic illnesses like Mr. Daviss, care can be very costly, especially when the patient is unable to oblige routine medical care or visits and medications. W ithout routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent fatality room visits and hospitalizations increasing costs for state and local government as well as tax payers.Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a flying fix of his symptoms and not address his health care needs. One realizable solution for the state and/or local government to consider would be to offer state funding for patients with chronic illnesses to be covered by a state funded insurance plan based on the patients income. This would allow for Mr. Davis to be seen for routine care, in an attempt to restrain him healthy and reduce emergency room visits and hospitalizations. Another possible solution would be for local and state governments to fund healthcare facilities and/or clinics designated to care for patients with chronic health conditions providing public health nurses who are available to visit the patients in the home in order to educate him or her on affection and disease processes.Though Mr. Davis is frustrated with the healthcare delivery in the United States and may think he would be better served in another country, he may be gravely disappointed by in their healthcare delivery systems even more. Countries such as abundant Britain, Japan, Germany, and Switzerland offer public health insurance, however coverage does not come without strain. The universal health care coverage plans not only causes capital deficit to the economy, but they also come with premiums, delays in care, and often times no choice of providers. Specialty appointments are nearly impossible to obtain, and in many cases terminally ill patients die prior to receiving the needed care. The plans cover the person and his or her dependents (plans including dependents have higher premiums), but the insured is still responsible for a portion of the services or bill this applies to the sr. as well. The universal health care plans not only simulate the insured, but the healthcare providers as well.In many cases, the healthcare workers are paid lower wages and work less hours in order to help offset some of the costs. The universal health plan in Great Britain offers residents no choices in regards to providers or facilities in which care is acquire and it is required for the patient to wait 122 days just to receive a routine appointment regardless of their condition (Healthcare Economist, 2008). Japans theme Health Insurance covers those individuals and their dependents that are not eligible for employer-based insurance. However, the focus of coverage is on the older population benefiting the retired community. If the insured is not of retirement age, the costs of premiums are higher (Fukawa).In Germany, less than 1% of the population is not covered by the Public Health Insurance. Germanys healthcare plan offers the insur ed free choice of outpatient care physicians and hospitals if referred with the focus of care creation on chronic care (Busse). Germany offers coverage for the following services preventative care, inpatient and outpatient care, physician services, mental health care, dental care, prescription drug coverage, medical aids, rehabilitation services, and sick leave compensation (Busse).In Switzerland, there is no choice of providers or facilities in which the patient receives care due to private sector. This means patients like Mr. Davis would incur increased premiums and resulting in modified access to routine care and extended services (Clarke, 2011). Based on the different types of coverage available to patients offered under universal healthcare plans, Mr. Davis would be better served and cared for with the German Healthcare System due to the type of disease he has and his particular health care needs.ReferencesBusse, R., MD, MPH. The German Health guardianship System. Berlin Uni versity of Technology & Charite. Clarke, E. 2011. Healthcare Systems Switzerland. CIVITAS Institute for the Study of Civil Society. Retrieved May 5, 2012 from www.civitas.org.uk/nhs/switzerland.pdf-0 FAQs for Employees About COBRA Continuation Health Coverage. Retrieved May 5, 2012 from http//www.dol.gov/ebsa/faqs/faq-consumer-cobra.html Fukawa, T. Public Health Insurance in Japan.Healthcare Economist, 2008. Health Care Around the World Great Britain. Retrieved fromhttp//healthcare-economist.com/2008/04/23/health-care-around-the-world-great-britain/ Medicare.gov, 2011. Retrieved May 5, 2012 from http//www.medicare.gov/navigation/medicare-basics/medicare-benefits-0 http//www.civitas.org.uk/nhs/switzerland.pdf