Knowing Medicare Options
by Ricky Ocampo RN
It
appears the nation's woe for affordable healthcare has led the federal
government to take action in educating the country on its options and ensuring
accessibility to government enforced and regulated plans, but for skeptics of
government competence, no songs of praises will be sung until an extensive
assessment of how resourceful, affordable, accessible, and generally effective
the options are has been conducted. Medicare.gov is the web-based one-stop
information center for all topics and dynamics associated with both signing up
for and accessing Medicare services (Medicare, 2015). Instant usability
consideration is found in URL address of the website alone; Medicare is all
that's needed to be remembered, and aside from this, the .gov domain provides
users with confidence that the site is an official government one. The process
of shopping for health insurance can be very complex and frustrating if one
isn't completely sure of which option one wants beforehand, and it's nearly
impossible to be sure of such factor without being aware of what options are
available. Luckily Medicare.gov has all of the necessary information collected
on site. Admittedly, the many links, pages, and texts available on the website
can make the website appear intimidating to some users; it's likely that
information of such scale can make healthcare appear more complex than it
actually is. On the home page for instance, even something as simple as placing
the mouse cursor over the 'Sign Up/Change Plans' tab reveals a scripted display
of more links and options. The positive side of the amount of information
available on the site is that it would only be more frustration if—at the end
of it all—one isn't able to find answers to questions one might have, but this
is very unlikely to happen.
One thing to naturally expect is
that the process will consist of filling out a lot of forms and completing
various assessments and surveys. Initially, one has to first determine
eligibility. Right away upon entering one's age, the criteria are simple. As
the site blatantly warns, “Medicare is for people age 65 and older and those
who have special condition or disability” (Medicare, 2015); anyone short of
meeting this requirement will not be able to move on the next step. Medicare
plans are generally divided into two main options: Part A and Part B. Part A is
explained to cover hospital care, skilled nursing facility care, hospice,
nursing home care, and home health services. It's explained that “Medicare Part
A (Hospital Insurance) covers hospital services, including semi-private rooms,
meals, general nursing, drugs as part of your inpatient treatment, and other
hospital services and supplies”, elaborating that “this includes the care you
get in acute care hospitals, critical access hospitals, inpatient
rehabilitation facilities, long-term care hospitals, inpatient care as part of
a qualifying clinical research study, and mental health care” (Medicare, 2015).
Things like private duty nursing, unneeded private rooms, television/phone in
the patients' room, and personal care items like slippers and socks aren't
covered. For skilled nursing facility coverage, Part A covers the typical
provisions like a semi-private room, meals, skilled nursing care, physical and
occupational therapy, speech-language pathology services, medical social
services, medications, ambulatory services, dietary counseling, and more
(Medicare, 2015). Part A also covers long-term care hospital (LTCH). The
website explains that “generally, you won't pay more for care in a long-term
care hospital than in an acute care hospital. Under Medicare, you're only
responsible for one deductible for any benefit period. This applies whether
you're in an acute care hospital or a long-term care hospital (LTCH)”
(Medicare, 2015). Part A also covers hospice care and home health services.
Generally, Part A is likely to cover all that an elderly patient would need,
unless such patient has multiple illnesses that require very specific and
exclusive attention and treatment. Upon assessing the coverage of Part A, it's
perhaps a bit more practical to press on towards viewing the provisions of Part
B, as opposed to just settling for Part A.
Part B of Medicare is immediately
explained to cover medically necessary services and preventive services.
Clinical research, ambulance services, durable medical equipment, mental
health, inpatient, outpatient, partial hospitalization, obtaining a second
opinion prior to surgery, and more, are all listed as services covered under
Part B. Part B covers and Part A cover clinical research, “which help doctors
and researchers see if a new treatment works and it's safe” (Medicare, 2015). The
ambulance service coverage is rather extensive, as it includes aircraft
transportation, given the condition that the patient's location can't be easily
reached by land vehicles, and/or the patient's condition is too critical to and
obstacles found in land travel—heavy traffic and distance—can take away from
crucial time the patient might not have. A third option is Part C, which is
also referred to as Medicare Advantage (MA), includes both Part A and Part B,
and is covered by private insurance companies that have been approved by
Medicare. Most programs require the use of doctors provided by MA, otherwise
one would have to pay some or all of the costs out of pocket. Most people pay
104$—the Plan B premium—a month for MA but usually pay additional monthly premiums
to get MA. Medicare also warns that one may “pay a copayment or coinsurance for
covered services. Costs, extra coverage, and rules vary by plan” (Medicare,
2015). MA plans costs would appear worthwhile due to the factor that—as
Medicare boldly declares—they cover all Medicare services. Lastly, Part
D simply covers medical prescription drug costs. Admittedly the Part D appears
a bit more complex than what just drug costs coverage would initially appear to
involve. For instance, prior authorization might be required, meaning—as
Medicare explains—that one's prescriber must contact the drug plan before you
can fill certain prescriptions, as the prescriber “may need to show that the
drug is medically necessary for the plan to cover it” (Medicare, 2015). There
are also limits on how much medication a patient can get at a time, and for
sleep therapy, the patient must try a similar drug of lower costs before the
plan will cover any further prescriptions. After having learned the provisions
and limits of each option, one central factor that might be an important part
of the decision making process is that of costs. A Part A cost is set at a
monthly premium of $407, and Part B is $104.90/month for most people. Part D
costs are a bit more complex as they're codependent on the amount of annual
income the customer makes. People who make under $85K get the Part D coverage
as part of their regular coverage (Part A or B), and people who make over $85K
pay a $12.30/month premium, in addition to the costs of their regular coverage;
people who earn between $107K pay $31.80 in addition to their regular Medicare
premium, people between $160K and $214K pay $51.30 in addition to their regular
premium. Lastly, people who earn above $214K pay $70.80.
Upon a close assessment of the
costs/coverage of each option, it would appear that Part B is perhaps the most
practical option. Part A, while being adequate for covering a basic patient
with no chronic illness, it doesn't appear to be ideal for patients who are
likely to fall ill; such patients can be hung out dry upon realizing the
treatment needed by their sudden illness isn't fully covered by Part A. Part B,
on the other hand, appears to provide nearly as much coverage as Plan C, but
leaves room for incidences where the patient isn't ill enough to need all of
the coverage provided by Plan C, where he/she would have to pay a higher
premium and be possibly left to cover part of the overall costs. Part D is
obviously not ideally meant for being the only form of coverage any patient
would have. Part D should generally be ignored as it's not needed if one has
any of the other three options. From all
of the information provided, Plan B is perhaps the best way to go, for the
preceding premises established.
To conclude, generally, the decision
making process isn't necessarily complex, but is rather intimidating, as all of
the content on the website can be seen as overwhelming to people shopping for
coverage. The contexts within the site are made for people over the age of 65,
but it's very likely that people of such age would need the assistance of a
younger professional to guide them through the process. In the long run, it's
all there—everything that needs to be known. The website takes on a simple and
clean presentation focused solely on providing clear and direct information, in
contrast of flash and attention retention. Medicare can perhaps benefit from
simplifying and/or reducing the amount of links and sub links and texts
available on each page, so older adults who are less computer-savvy won't find
the site to be confusing and not resourceful.
References
Medicare.
(2015, January 1). Medicare.gov. Retrieved March 5, 2015, from http://www.medicare.gov/
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