Nursing: Benchmark Assignment - Medicare Part D
Introduction
This assignment examines a healthcare policy, which could be changed based on the way it functions currently. From my research Medicare part D legislation aligns with this category for consideration. However, before advancing my arguments it would be clarifying to recap on features of the entire Medicare policy and how it serves the interests of persons beyond age 65 years old along with young disabled persons. This policy was instituted to provide healthcare coverage for legal United States residents who have attained the age of 65 years old. They must be in legal status at least 5 years prior to applying for this benefit. Younger people with health disabilities are also entailed to Medicare coverage. Currently there are four part to Medicare coverage to which beneficiaries can access various aspects of health care. It encompasses Parts A, B, C and D (Silverman & Skinner, 2004).
Currently, while all parts of the program are federal controlled, some 30-50 private insurance companies are utilized in supplementing care for the elderly. Funding is provided from payroll taxes. Medicare part A covers hospice and hospitalization; part B pays for services not covered under Part A such as chiropractic care, out-patient services, visiting nurse and diagnostic testing. It also pays for durable medical equipment such as wheel chairs and oxygen. Part C known as Medicare plus choice plans offer additional healthcare services which may not be covered by original Medicare. However, to be eligible for part C participants must enroll in parts A and B to be eligible for the benefits (Silverman & Skinner, 2004).
Medicare Part D
The legislation that seems to be changed or reformed relates to Medicare Part D of the Medicare provisions offered for the elderly and disabled. All the other three parts already have their fair share of problems, but with the introduction of Part D which took effect January 1, 2006 all beneficiaries who enrolled in Parts A and B became eligible for Part D. While this section covers access to self-administered drugs the elderly are still encountering immense difficulties paying for prescription medications. As such, in my opinion the federal government should be approached through lobbyists in attempting to modify this policy so hardships among the elderly and disabled could be reversed. Why is it that s separate section or policy is enforced to covered self-administered medication when parts A, B and C in particular cover aspects of health care that relate to treatment (Silverman & Skinner, 2004).
This policy became law through reactivation and reform of the 2003 Medicare and Modernization Act. Additionally, this Act forces the Medicare beneficiary to enroll in a stand-alone plan. These plans have their peculiar dispensation difficulties. For example, drugs and copayments vary from one state to the other. As such, a beneficiary who lives in New York may pay a higher drug premium than one residing in Florida. Clearly, these plans create immense disparities among the elderly who paid into this fund through their tax dollars. Unfortunately, both insurance companies and pharmacies have the option of selecting drugs categories covered in each plan. As such, beneficiaries apart from being disenfranchised due to geographic location also have the added disadvantaged of limited drug coverage due to the plans that were selected/ chosen ( ).
According to federal law, supplemental insurance companies must offer at least two drugs from the 148 different drug categories. However, they must offer all drugs in the anti-convulsive, anti-cancer, psychotic, HIV/ AIDS, anti-depressants. The more devastating aspect of Medicare Part D that really needs reconsideration relates to the fact that some important drugs are excluded from coverage entirely. If beneficiaries need them, the specific plans must cover them or clients for them out of pocket. This often devastating and very difficult. Advocates for the continuance of Medicare part D and the rigid drug coverage for the elderly and disabled contend that some states have designed assistance for persons who cannot afford to pay for their drugs. However, the eligibility process to qualify for such services I very difficult. In meantime persons seeking drug assistance dies or the condition reaches to the stage of merely hospice intervention (
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Conclusion - The Desired Change ( Plan)
After a careful examination of the inefficiencies contained in Medicare administration of
upon the elderly as an entire program along with the added undue harsh imposition of Part D, a change in policy is mandatory. The policy must eliminate private insurance companies along with pharmaceuticals being given opportunities to regulate the type of drugs can select for their treatment. Elder abuse is escalating in nursing homes along with assisted living facilities. These issues suggest that in Medicare administration there are subtle features of elder abuse identified in controlled drug access policies. Besides, there are studies that prove part D policies to have created many hardships for the elderly . Often, they must decide whether to eat rather than buy drugs they need which are within the excluded category (Yin, Basu, Zhang & Rabbani, 2008).
Therefore, mandatory representation must be made for repealing of Medicare part D making it inclusive in Medicare parts A, B and C coverage. In this way drug usage/ selection would not be controlled by insurance companies and pharmaceuticals.
Stakeholders to implement change
Lobbyists’ originating from interest groups such as church leaders and eldercare organizations. Next, the state senator would be approached after signature obtained through petitioning.
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References
Silverman, E., & Skinner J. (2004). Medicare upcoding and hospital ownership. Journal of
Health Economics. 23:369–89
Yin ,W. Basu. A, Zhang, J. & Rabbani A. (2008). Impact of the Medicare Part D Prescription
Drug Benefit on drug utilization and out-of-pocket expenditures. Annals of Internal
Medicine. 148:169-177.
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