1 Doughnut hole refers to the Medicare Plan D’s coverage gap for prescription drugs. Pt’s that have this plan can expect having their medications covered up to $2850 per year, the problem is that if their medicines are higher than that, they would need to pay 100% of the cost out of pocket; If the cost goes higher than 4550/year, called a catastrophic level, then coverage starts again. 2 3 That means that patients who are very sick and need lots of medications, or expensive drugs, need to come up with $1700 to cover their meds between $2850 and $4550. In my personal opinion, that is a lot of money for many lower-income participants in the plan. Their only options are either they pay higher insurance premiums, or they pay the out-of-pocket money to bridge the coverage. 4 5 The implications for us a APNs is that some patients might not be able to afford their medications, and we should be aware of that when prescribing, either we can prescribe a generic, or cheaper option of a medication, or we can research about other option like subsidies, or grants, etc. and facilitate their way to access those. 6 7 …show more content…
Basically as future APRNs, or even owners of our own medical services, we should know these programs very well because there is an increasing segment of the population that uses them and we will be serving them and optimizing our services to their needs, based in how they are covered and what they can afford too, this is of special importance for low-income patients. I learned that even though the programs are not perfect, they provide equity by subsidizing the cost of health insurance for the elderly and some special groups in the
(II) The enacting of Medicare Part D in 2006 only helped to fuel America’s hunger for prescription medication. In 2003, President George W. Bush announced and signed the Medicare Prescription Drug, Improvement, and Modernization Act (also known as the Medicare Modernization Act, or MMA) on December 8th. The roughly $400 billion dollar measure was marketed to the American public as something that will provide care for the millions of senior citizens who, at the time, were struggling to afford prescription medication. This was the largest development of Medicare since 1965, which is when the program was initially created, and gave hope to those wishing for positive medical reform. According to title XI of the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, the most significant change will be the affordability of prescription drugs by implementing the importation of drugs from Canada, along with necessary safety measures, in order to lessen the cost (United States Congress, 832). For those who were in retirement homes and lacked a steady income, the affordability of drugs was often a deciding factor in the decision to seek medical attention and the idea that those individuals ceased to live simply because they lacked the funds tugged at the heartstrings of many Americans.
After Medicare covers up to a certain amount, individual will enter what is called a Donut-Hole in their coverage, which means that they will be paying more out-of-pocket for prescription and health needs (Pros and Cons of Medicare Part D Coverage, n.d.). The implementation of the Part D program was a huge undertaking accomplished very quickly. Unlike other benefits available under traditional Medicare, Part D is administered through almost 1,900 stand-alone prescription drug plans (PDPs). Part D coverage is also available through more than 1,000 private Medicare Advantage Part D plans (MA-PDs) that provide Part A (hospital insurance) and Part B (supplementary medical insurance), as well as Part D prescription drug benefits (Oliver, T. R., Lee, P. R., & Lipton, H. L.,
While many low-income families obtain prescription coverage through government programs and may receive relatively generous drug benefits, those who have no prescription coverage are required to pay the full retail price charged at their pharmacies. Because the cash-paying customers are
The question, however, is whether or not such drug coverage is a worthwhile project to undertake. Is the problem indeed serious enough to call for the type of reform that the candidates are proposing? Medicare is already a very costly program to keep up, and adding prescription-drug coverage would increase these costs even more. In order to fund this project, there will need to be a tax hike. Should taxpayers subsidize this prescription-drug benefit? Is there a good reason why this redistribution should take place? What are the benefits and costs of this proposal? These and other questions will be addressed in this paper as we examine the following topics: the need for senior citizens to have prescription-drug coverage, the political rhetoric involved with this issue, the projected shortfall in the budget of the Medicare program, and who really would benefit if a prescription-drug benefit was added to Medicare.
Luckily under the new health care reform law, most people will receive help paying for their healthcare premiums and cost-sharing expenses that people with insurance have to pay out of pocket for doctor visits, and prescription medicine. Families and individuals will be able to receive this assistance with incomes between one hundred and four hundred percent of the federal poverty line. One hundred to four hundred percent makes up at about $23,000 to $94,000 a year assume this is for a family of four.
The passage of the Affordable Care Act (ACA) in March 2010 represented a significant turning point in the evolution of health care in the United States and presents boundless opportunities for APRNs (The Patient Protection and Affordable). The ACA promises to add 32 million Americans to the rolls of the insured amidst a shortage of primary...
The United States spends more per capita on health care than any other country, with the percentage of gross domestic product dedicated to health care doubling from 9% in 1980 to 18% in 2011(Kesselheim,). One of the contributors to health care inflation is prescription drugs. Pharmaceuticals account for about 10% of total health care costs, spending on pharmaceuticals is poised to swell in upcoming years as a result of the increasing prices of complex specialty medicines (Kesselheim). Name brand drugs are going to have to be set at higher prices, in order for pharmaceutical companies to receive a profit. If the patient has full coverage on a medication, there is a greater chance that medication will be taken, although it may not be
In the article titled, "Health: Medicare and the Economy," by: Dean Foust, found in Business Week and published in 2004, it is stated that, cuts in Medicare would be bad for hospitals and other managed-care providers. Although the United States is considered the strongest country in the world, there are numerous political, social, and economic issues that require reform to improve our way of life. Reform is needed for the health care system in order for Americans to live a life that is both safe and prosperous. Health care and prescription drug costs, whose escalating prices have caused many Americans to go without adequate medical care. Health care is one of the most controversial issues in the news right now. The co...
Phillips, K. (2009, September 1). Catastrophic Drug Coverage in Canada (PRB 09-06E). Parliament of Canada . Retrieved March 12, 2012, from http://www.parl.gc.ca/Content/LOP/ResearchPublications/prb0906-e.htm
Even with health care coverage being at the tips of our finger, we still are positioned with the question how will I pay for this, as well as where this money comes from. Reports have indicated that the United States has spent “$2.2 trillion for health care in 2007, which was an increase of 6.7% from $2.1 trillion in 2006” (Wexler). This revenue comes to all of our taxable expenses, which in turn trickles down to the Affordable Care Act. Receiving any medical care, is expensive in general, from staffing of the hospitals to creating the medication that someone needs to further their lives. Wexler addresses the increase of medication production. ” One of the fastest-growing components of health care is the market for prescription drugs. In 2006 Americans spent $216.7 billion on prescription medication—this was an 8.5% increase from $199.7 billion in 2005” (Wexler) The increase can be a good way to think of how the money is spent. We fund the projects that in turn create fundamental medications to help those who need
... more prone to chronic illnesses. As for Medicaid, it needs to improve its chronic care management. Chronic care management should be made more affordable to those with chronic illnesses (Baicker, Katherine, & Amy Finkelstein, 2011). This way, the program will be more beneficial to more people. The program should also introduce, and support home and community based services. Providing care in home settings will be much cheaper than nursing homes. Moreover, Medicaid needs to come up with customized beneficiary services. Patients’ needs are not equal. Therefore, Medicaid should be flexible enough to abandon the one size fits all mentality. Anyway, that notwithstanding, we cannot ignore the fact that Medicare and Medicaid have revolutionized healthcare in the United States. Giving credit where it is due, these two programs continue to save millions of helpless lives.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
There are three issues when it comes to the health care cost rising. The first is the rising cost in prescription drugs. The second area of rising cost is the increased technologies when it comes to the medical industry. The third problem is the aging population. Prescription drugs are the area of the fastest growing health care expense, and it is projected to grow at 20 to 30 percent each year over the next several years. There are many newer, more expensive drugs on the market, and the use of these prescriptions is exploding. In addition, with so much television advertising, many consumers ask their doctors for expensive, brand name drugs when there may actually be a generic drug that works just as well.
Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.