Why it important for nurses to understand health care financing
The current healthcare setting is characterized by insistence on monitoring and evaluation of patient outcomes. These patient outcomes have expanded and the focus on costs of care as direct indicators of patient outcomes all but reflects how the role of the nurse may have equally expanded. Nurses have long been regarded as patient advocates and they still remain so even in the current context even with more roles to play in this advocacy aspect (Sherman & Mary Bishop, 2012). The patient-centric care approaches place their emphasis on the patient as the center of attention and the primary element of care. It seeks to tailor the interventions to the patient based on the recognition that patient-specific factors have significant influence on the ability of the proposed interventions to offer recovery or restoration. In the contemporary healthcare environment which is characterized by holistic healing processes, nurses have to remain adept with the social, economic and cultural elements that influence the patient’s health (Sherman & Mary Bishop, 2012).
With the healthcare sector largely taking a commercial and open market system, nurses have to play the role of teachers so as to help patients make appropriate decisions in choosing the best insurance or financing plans that suit their health needs and that reflect their social and economic status. Apart from the patient centered education on choosing and selecting healthcare plans, nurses have to recognize that they hold significant influence on the optimization of resources within the sector. They have to make an understanding and a link between high quality care and the concurrently ensure cost savings and accessibility of care by the population (Sherman & Mary Bishop, 2012). In Vera’s case for instance, the nurse has to take into consideration the fact that Vera needs to continue his oncology visits even amidst the financial limitations that she has narrated. The nurse has to help explore the remaining options and ensure that Vera continues his treatment plan to the very end.
Why Vera is no longer eligible for COBRA benefits
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is essentially a federal law that allows employers who have resigned or have been terminated from employment to continue or remain within the health plan of their former employer past the employment period. However, it is the duty of the employee henceforth to pay premiums and the COBRA law does not afford any special benefits to the individual (U.S. Department of Labor, 2015). In some instances the employer can subsidize the premiums even for the former employees but this is based on mutual relations and not in any way required by the law. While there exists no primary financial benefits or costs savings with COBRA, it is a preferred health plan because at least the individuals are assured that they their insurance provider cannot cease to exist with short notices or without them at all. In most cases, it is possible that one may lose all the benefits associated with COBRA especially if they are unable to cater for the premiums like in Vera’s case. However, there is still a law that gives the employee the room to elect the benefits; this law is inflexible and has no excuses or no grace period. This law states that employees upon the receipt of written notification from their employers that they are under COBRA and have rights under COBRA they can elect the benefits of COBRA even past employment and thus use the same rights to seek medical care (U.S. Department of Labor, 2015). Vera did not elect the benefits for her continued coverage on the 60th day thus rendering her uncovered past that day upon receipt of the COBRA notification. Secondly, for Vera, the fact that she failed to pay the premiums also rendered her uncovered henceforth, the COBRA law is very strict and most people do not want to mess with it especially in regard to timely payment of premiums. However, in the first premium payment, COBRA allows for untimely payment which is usually justified by miscommunication issues (U.S. Department of Labor, 2015).
Advice to Vera
Vera is in a very precarious state; she has already lost her COBRA rights she is not eligible for Medicare apparently because she is not old enough for eligibility and she is not eligible for Medicaid because she is not poor enough. Apart from this, she has used the available finances and the back has failed to offer her a mortgage for her house for the second time simply because she is not employed (Centers for Medicare & Medicaid Services, 2015). Since Vera was laid off two years ago, it is not currently possible to enroll for Medicare Part B even if she had Part A as the eight month grace period for doing so has already elapsed and in any case she had not enrolled for Medicare Part A as her primary insurance provider. She only has one option if she has to continue her treatment and that means to seek the Medigap protections or the guaranteed issue rights that an insurance company has to offer in such a case where eligibility to any other of the policies is limited and the individual has a preexisting condition from her previous health insurance plan. In this case, all companies are required to sell the individual a Medigap policy that covers for all the stated and approved preexisting conditions without requiring the client to pay more for the past or current health problems (Centers for Medicare & Medicaid Services, 2015).
References
Centers for Medicare & Medicaid Services. (2015). Guaranteed Issue Rights | Medicare.gov. Retrieved from https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-scenarios.html
Sherman, R., & Mary Bishop, D. N. P. (2012). The business of caring: What every nurse should know about cutting costs. American Nurse Today, 17(11), 1-3.
U.S. Department of Labor. (2015). COBRA Continuation Coverage. Retrieved from http://www.dol.gov/ebsa/COBRA.html
