NURSING

Health Insurance

Health Insurance

Introduction

The Medicare plan is one of the leading health insurance plans offered by the US government to elderly people; however, the plan does not encompass all the aspects well. There exists the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) for group coverage to people who have lost their jobs. The health insurance system in countries like Switzerland and Japan is better than the one in the US. The country faces financial challenges that need to be eliminated in order to improve the provision of decent health insurance coverage. The ethical implications of providing information to patients about their cost coverage need to be considered. It is the right of the patients, under plans like Medicare, to have access to correct information regarding the coverage of their medical expenses.

Discussion

Scenario 1: Part A - Cost Coverage

Medicare Part A

The coverage in Medicare Part A will address the inpatient care that Mrs. Zwick received while in the hospital and the skilled nursing facility for rehabilitation. Medicare Part A also covers the costs of hospice care services and home health care services. Generally, this means you pay a one- time deductible for all of your hospital services for the first 60 days you are in the hospital. All the expenses for Mrs. Zwick's stay in the hospital and rehabilitation facility will be covered by the plan.The tests, x- rays, and all other examinations are included in the cost (Medicare, 2011).

Medicare Part B

This part of Medicare covers all the necessary medical services such as doctors' services, home health services, outpatient care, durable medical equipment and other medical services. The medical services and supplies, used to diagnose and treat the patient, are all included in this part. In Mrs. Zwick's case, the walker prescribed to her after discharge will also be covered, in addition to the other services, and supplies used for the treatment (Medicare, 2011).

Medicare Part D

Part D addresses the drug prescriptions given to the patient by the medical institution. The medications prescribed to Mrs. Zwick will covered in this part; however, once she reaches the coverage gap, the coverage halts. This coverage gap is a temporary limit on the drugs. Since Mrs. Zwick's illness is life- long, she is bound to reach the coverage gap. This coverage gap initiates after the plan holder or the drug plan have spent a fixed amount for covered drugs. The positive aspect of the coverage gap is that Mrs. Zwick will have to pay only 50% of the cost of the brand name drug. There is a 50% discount given by the manufacturer of that brand name drug. The coverage gap ends when the patient reaches a specified amount spent by them on the prescribed drugs. There are variations in the coverage plan according to specific patients and their selected plan (Medicare, 2011).

Scenario 1: Part B - Effect of Policies on Reimbursement for Additional Care

The additional care here comprises of the hospital- acquired urinary tract infection. Since Mrs. Zwick and her daughter are not aware that the ...