KOT Task #2: Medicare
Western Governors University
Though Medicare plans are typically for persons over the age of 65 years old, they do not come without costs to the patient. If the patient has enough work credits, Medicare Part A is automatically available to the patient once he or she reaches age 65. Medicare Parts B and D, however, require the patient to navigate through an application process and the patient may incur penalty fees if he or she does not sign up for the plans during the allotted time frame once they have reached the age of 65. For Medicare parts B and D, the patient is responsible for paying the designated premiums. The Medicare Part B premium ranges from $96.40-110.50 monthly and the Part D plan ranges from $28.60-$38 monthly. There is also additional Medicare plans available for the patient to purchase through insurers such as Blue Cross and Blue Shield or Etna, however there are additional premiums in varying amounts (Medicare.gov, 2012). In most cases, Medicare Part A will cover inpatient hospital stays, rehabilitation centers, and long-term care facility stays. For Mrs. Zwick, Medicare Part A would apply to the rehab and inpatient hospitalizations. Medicare Part A will cover Mrs. Zwick’s five day hospital stay and the first 20 days of her stay at the rehabilitation facility. Each day following the first 20 days of rehab, a fee of $144.50 per day will accumulate at the rehabilitation facility for a total of $2890.00 which the facilities will be responsible for due to the patient acquiring a preventable infection during her stay (Medicare.gov, 2012). Medicare Part B is similar to medical insurance; covering medically necessary services such as MD visits and services, outpatient care, durable medical equipment, home health services, and sometimes preventative care services. In Mrs. Zwick’s case, Medicare Part B would cover the prescribed walker or other assistive devices if needed. However, based on Medicare Part B plan coverage, Mrs. Zwick will be responsible for a deductible of 20% of the cost of the walker (Medicare.gov, 2012). Medicare Part D is an elective prescription drug coverage plan available to Medicare recipients. There are various prescription drug plans offering medication coverage based on the plan’s preferred drug list. Though Mrs. Zwick’s plan coverage was not specified in the case study, she may be responsible for a co-payment for prescription drugs. If Mrs. Zwick does in fact have a co-payment, it would be a set amount; for example $10 per prescription or less if she receives generic drugs. Or, depending on if Mrs. Zwick has entered a coverage gap or “donut hole”, she will then be responsible for 50% of the costs of her prescription medications (Medicare.gov, 2012).
Though Mrs. Zwick does have Medicare coverage, the plan may not pay for Mrs. Zwick’s extended stay or additional care required related to a hospital-acquired condition. In recent years, Medicare began refusing to pay for preventable, hospital acquired infections; making hospitals and other facilities accept responsibility for preventable infections acquired during the patient’s stay. However, in Mrs. Zwick’s instance, there may be some debate as to which facility will be held accountable for the preventable urinary tract infection (UTI). Though the case study reads that Mrs. Zwick was diagnosed with a hospital-acquired UTI, it also states that she was diagnosed 10 days into her stay at the rehabilitation facility and that there were complaints that Mrs. Zwick was not receiving proper catheter care. If the rehab facility was not following the current evidence-based protocol related to the patient’s catheter care, there is a strong possibility Mrs.Zwick did not acquire the urinary tract infection until after she was transferred to the rehab facility. Therefore, the hospital would not be responsible for the costs of care related to the UTI. However, Medicare...