Analyzing Medicare, Essay Example

Consider the following situation.

Your son has taken the job at Costco and made friends with a colleague who is retiring at age 65. She is impressed by your son’s knowledge of the Costco health plan. At 65, she will sign up for Medicare Parts A and B. She wants help deciding whether to buy a supplemental Medigap policy, a Medicare Advantage plan, and/or Part D. Your son needs help from you again to help his friend.

Part One: In 300 words or less, explain how this woman’s health insurance coverage will be different under basic Medicare Parts A and B from her Costco plan. Be sure to consider cost— you may assume she has been paying $79/month for health insurance under Costco. You may use lists to compare but be sure to include some commentary.

In addition to Medicare Parts A and B, the client has the option of purchasing Medicare Part C, also known as Medicare Advantage, which is provided by a private insurer and includes Parts A and B, Part D, plus other options such as dental and vision coverage (Medicare.gov, 2012). However, each plan establishes its own premiums and out-of-pocket costs, depending on specific requirements (Medicare.gov). It would be up to the client to research the options and to determine whether or not the premiums are within her price range (Medicare.gov). A Medigap policy is in addition to Parts A and B and is similar to Medicare Advantage in many ways. Furthermore, Part D, known as prescription drug coverage, is largely provided by many insurers to better manage the costs associated with prescription drug needs. Medicare Part D is essential for any patient who requires prescription drugs for a variety of reasons, and covers both brand name and generic formulas (AARP, 2012). Based upon these alternatives, perhaps the best choice for her specific needs is Medicare Advantage, which includes Part D benefits, coupled with additional offerings (AARP, 2012). However, this also depends upon her specific needs and what might be required as a result of preexisting conditions or other issues that might be prevalent in the client’s medical history. In order to keep the premiums as close as possible to her rate at Costco, the client must make a decision that will provide her with maximum coverage at an affordable rate. Therefore, the client must make these comparisons and decide how to best approach the circumstances to achieve maximum savings.

Part Two: Assume your son’s friend will continue to live in Columbus, Ohio (zip code 43221, Franklin County). She has a preretirement income of about $55,000 and will have a retirement income of about $45,000 per year (She does not qualify for any subsidies.), is in “good” health, and has no pharmacy preferences. She will be signing up for Medicare for the year for which you are exploring premiums – be sure to use the latest year available. She takes no medications at this time. Her family has a history of high blood pressure and cardiovascular problems, but she has exercised and eaten well to avoid these. She has specified that she does not want to pay more than $155 per month in premiums (including her Part B premium) for health coverage and would prefer to be able to see her current doctor. She is not sure about the drug coverage since she takes no drugs currently. She also travels in the U.S. to visit grandchildren, so would be concerned about coverage while she is away from home.

1. Using the table provided, please consider the four options we have selected for your son’s friend. (These are not necessarily the best, but are good for comparison purposes.) Consider what the potential impact of each provision in each plan is for this person. Except for the premium box, you should not just enter numbers. Rather, explain how the options compare on each feature. Remember, this woman can change plans at the end of any year (but will need to do this analysis again!).

Assume hospital stays of less than five days (notice the rules about benefit periods), outpatient preferred generic and preferred brand drugs from retail pharmacy only, all services as considered Medicare-covered, and billed charges within Medicare limits. Please figure out what the “gap” in Part D coverage is, but disregard it in your answers in the table.

MHA Module 1: Context of Leadership in the U.S. Health Care System

Week Seven Assignment One: Analyzing Medicare

Part Two: Given the friend’s scenario and your study of the Medicare Web site, complete this table.

References

First Health Premier (2009). 2009 Summary of Benefits. Retrieved from http://www.firsthealthpremier.com/content/items/13507/FH09SB23_91311. Pdf Medicare (2012). Retrieved from www.medicare.gov

Medicare.gov (2012). Medicare Advantage (Part C). Retrieved from http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-c.aspx