Medicare Role In Health Care

The idea of a national health insurance system was presented in the beginning of the twentieth century during President Teddy Roosevelt’s candidacy (cite). However, the system was not created until 1965 as President Lyndon B. Johnson signed a bill, establishing both Medicare and Medicaid (cite). Initially, Medicare served to provide health coverage and payment of doctor and hospital visits, dental care, nursing services, etc. (cite). At the time, only 56% of individuals over the age of 65 acquired health insurance, thus leading Congress to extend the benefits in 1972 to end-stage renal failure and disabled patients, along with patients over 65 years of age (cite). Since then, Medicare has developed into a vast system with several coverage plans.
A nurse should briefly orient himself/herself on the history, available and limited services, and benefits of Medicare. Available services include hospital and doctor visits, skilled nursing facilities, hospice, surgeries, and home health care (cite). On the other hand, limited services include medical equipment, preventative services, and laboratory tests (cite). There are also medical expenses not covered at all including dental care, dentures, eye examinations, hearing aids, and long-term care (cite). It is highly important that a nurse remain considerate of all patients, but especially Medicare patients. If a nurse is responsible for placing dentures in a labeled, plastic cup, but the dentures are later found in the garbage, the patient is now possibly in a predicament as Medicare does not cover nor replace dentures. This also causes the hospital to lose money as they would usually replace the dentures if it were their fault. Having knowledge of Medicare policies should heighten the nurse’s sense of responsibility when caring for a patient. When a patient presents with a problem, the nurse is able to analyze the situation and provide positive, beneficial advice. A nurse’s knowledge of Medicare reflects in his/her care for the patient and will drive every decision he/she makes while providing
Employment and personal relationship/ social support are critical areas to be assessed during the health history. As of 2014, 53.8 million Americans are provided health insurance through Medicare, with 83.5% being aged patients (cite). Due to this statistic, it is necessary to consider the employment and financial status of the patient. Usually, a Medicare patient will not be employed and will be living off of a fixed income. This should affect how the nurse then views the patient’s ability to obtain medications. Drugs in lower tiers generally cost less than those of higher tiers (cite). The nurse’s role in medication is to advocate for the patient to obtain orders for a lower tier medication that is both therapeutically effective and cost efficient. Given the provider insists the patient receive a higher tier medication, the nurse can educate the patient on the “exception” option offered by Medicare to receive the higher tier at a lower price (cite). The same concept applies to personal relationships and social support. Upon discharge, if a patient is unable to drive and has few or no family members available for transportation to future appointments, a nurse is able to offer assistance in connecting the patient to a home health service if needed given her knowledge of home health Medicare