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Jenny: Medical Decisions

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Making health insurance decisions may sometimes be challenging for an individual who is making an application for the first time. The Medicare plan options offered by the government vary in many ways. As Barry (2014) notes, people can choose to take insurance policy option A, B, C, or D based on their personal needs, and the state in which they live. Some states do not offer all the four available options. For this reason, one should ensure that the process of choosing the most appropriate option is based not only on the personal interests but also on other external drivers. As a first time applicant to the Medicare health insurance, it will be necessary to look at all the options which are available.

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Medicare Part A

The Medicare Part A covers inpatient care services and skilled nursing facilities for the beneficiaries. Also covered under this plan are home healthcare and hospice services (Leavitt, 2012). This Medicare plan exists in many states in the country and has remained very popular over the years. It is an appropriate insurance option for an individual who does not have a specific medical problem. A patient who has just turned 65 years of age and is worried of general sickness that is not specifically defined may find it to be the best option. However, one must fist determine if it is available in the state of residence. A further advice from the medical experts may be necessary to ensure that one takes the most appropriate cover which suites the personal needs. As Nee (2013) warns, sometimes one may be forced to take an additional cover when a wrong choice is made. When making the decision, the ultimate aim is always to ensure that the policy will cover as many of the healthcare needs as possible. It should be as comprehensive as may be possible to eliminate the extra costs of looking for an additional insurance policy. For those who are just getting into the system for the first time, and do not have a specific healthcare problem that needs special attention, this Medicare plan may be very appropriate for them.

Medicare Part B

The Medicare Part B is the most common insurance plan that is available in almost all the states in this nation. There are states that only offer Medicare Part B. In this plan, all the outpatient services are covered. When a patient get’s a specific service from a specialist, then such services are covered under this policy. It also covers the home-based health care and the medical equipment needed by a patient. According to Nee (2013), Part B of the Medicare is popular because it also covers preventive health care services that protect a patient from contracting specific diseases or stopping a condition from getting worse. These preventive services may vary depending on the vulnerability of a patient towards a given medical problem. This Medicare plan is very relevant to an elderly patient who may need diversified medical attention. Whether or not one is suffering from a specific disease, this insurance policy is most likely to cover the possible healthcare needs. This explains why it is the most common of all the four policies. I will prefer this Medicare plan for it is cheaper than Part C and D offered by private insurance companies, which, however, offer a more comprehensive cover that Part A.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, offers all the benefits provided under Medicare Part A and Medicare Part B. This means that under this cover, a patient who gets an inpatient or outpatient health care services will be covered. Home-based health care and skilled nursing facilities, including hospice services are available under this cover. Services of specialist doctors and preventive medical attention offered to the patient are also covered. As Barry (2014) observes, this policy plan is run by approved private companies that offer insurance policies. Another uniqueness of this policy cover is that it also offers the cover available under Part D of the Medicare plans. This means that prescription drugs are covered in this policy. According to Nee (2013), this cover may also include other extra benefits which are available at a small extra cost. This explains why it is mostly referred to as Medicare benefits. It offers unique benefits to the clients. Unlike the first two policies, this plan is run by private companies that have received Medicare-approval. This may partly, explain why it offers such a comprehensive cover.

Medicare Part D

The Medicare Part D covers the costs of outpatient drug prescription. The ultimate aim of this policy is to protect a client against a possible inflated cost of drugs in future by lowering costs of the prescription. Like Medicare Part C, this policy is offered by insurance companies which are privately owned as long as they have received the Medicare approval. This prescription drug coverage may be very broad in its offering based on the decision of an individual on what needs to be covered. However, this comes at an additional cost to the applicant. According to Kronenfeld (2013), this Medicare plan is very appropriate for individuals who know that their prescription drugs may be very costly either due to the frequency with which the drug is needed or the high cost of a single dosage. As a 65 year old, I would prefer having Medicare Part D as a back-up to Part B that I have chosen to use.

Reflection

It is clear from the task completed above that making a decision on the most appropriate cover plan is not a simple process. Numerous factors have to be considered before the decision can be made. Some plans are very attractive, such as Medicare Part C, but they come at an extra cost. This means that the decision maker has to weigh the benefits offered and the associated costs before coming up with a decision on which policy will be the most appropriate. The part of the assignment that was easy to complete was the section that entailed choosing the most comprehensive and appropriate cover of all the four options. One only needs to analyze what each option offers and decide on the option that is the most appropriate. For instance, it was established that Medicare Part C offers the most attractive package of all the four options. It is a comprehensive cover that offers all the benefits available in Part A, B, and D. It was very easy singling it out as a cover that may meet almost all the health insurance needs of an individual. It is also appropriate for people of different ages irrespective of their health conditions. Ranking the four options was also easy. After giving Medicare Part C the top spot, part B comes next in terms of the benefits offered.

The process of choosing the right Medicare policy that one should take proved to be a little challenging. It was established that ranking the insurance covers and getting the one which offers the best benefits is not enough. It goes beyond this first step. One will have to determine whether or not the chosen policy is available in his or her states. Not all the policies discussed above are available in all the states in this nation. Some of them may not be available in one’s state. This means that despite the attractiveness of a plan, one can only choose it if it is offered in the state of residence. When this has been established, then one will need to narrow down on the associated costs. For instance, Part C offers the most comprehensive cover. It is the most expensive cover of all the four options. At this stage, one will need to determine if he or she has the capacity to pay for the cost associated with the plan. After this issue is addressed, then one can be able to select the most preferred plan that best meets the personal needs. For the 65 year olds who are making such decisions every day, one challenge they face is how to match their specific health needs with the policies offered at the least cost possible. The most important lesson from this assignment is that there is a need to create awareness among this group on how to make choices when choosing insurance plans. This information will be used as a foundation to developing a base of knowledge that can be used by the elderly when making health insurance policy decisions.

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References

Barry, P. (2014). Medicare prescription drug coverage for dummies. Hoboken: John Wiley & Sons.

Kronenfeld, J. J. (2013). Medicare. Santa Barbara, Calif: Greenwood.

Leavitt, M. (2012). Medicare & you 2009. Darby, PA: Diane Publishing Company.

Nee, P. (2013). The Key Facts on Medicare: Everything You Need to Know About Medicare. Boston: Medical Center.

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