Medical care is more accessible and affordable thanks to Medicare. It targets people aged 65 and up. The plan also covers disabled under-65s who receive Social Security or Railroad Retirement Board disability benefits. Also, people with chronic diseases like ESRD or ACL qualify for Medicare (Bunis, 2021). Parts A, B, C, and D of Medicare Part A covers hospitalization, skilled nursing care, and hospice care. Medicare covers the first 100 days of care for patients in LTC facilities. The first twenty days are free, but after that, the patient must pay $164.50 per day until the hundredth day. Medigap insurance covers part B and part C respectively. PDR (Prescription Drugs)
In the case study, the patient cannot care for herself and needs to be placed in a nursing home. The patient’s Medicare plan does not cover nursing home services. For long-term care, she qualifies for Institutional Medicaid (Medicaid eligibility for Medicare beneficiaries in nursing homes, 2018). Personal, nursing, and therapy services in a nursing home are covered. As a nurse, I would advocate for the patient to get the services she needs for better health.
I would use specific tactics to get the needed help quickly. My first step would be to help the patient apply for financial assistance from the hospital’s charity kit. Many healthcare facilities collect financial resources and put them in charity kits to help patients who cannot afford the facility’s services. The patient would be able to get the primary specialized and personal care she requires (Medicaid eligibility for Medicare beneficiaries who need long-term care in a nursing home, 2018). The second step is to find appropriate nursing home insurance coverage. The patient may be eligible for Medicaid long-term care if she has a low income and pays Medicare Part B. I would gather all patient information and contact the appropriate insurance provider to begin the paperwork process. These steps would ensure the patient’s health.
Nurses and other health care providers must work together to advocate for patients. In this case, I would work with other healthcare professionals and stakeholders to ensure the patient was satisfied. I would ask the primary care provider and physician for detailed information about the patient’s health status and needs to qualify for the charity kit’s financial assistance. Collaboration with the healthcare organization’s eligibility officer would also help approve the patient’s financial aid request. Of course, the steps will be followed to ensure fairness and justice. Finally, I would work with the chosen health insurance provider to ensure that the patient receives all benefits related to nursing home care. This would improve her health.
D Bunis (2021, January 1). Understanding Medicare Parts A, B, C, and D AARP. https://www.aarp.org/health/medicare-insurance/info-01-2011/understanding medicare the plans.html
Medicaid eligibility for Medicare nursing home residents. 1 March 2018 Medicare Connect. https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/medicare-and-medicaid/medicaid-eligibility-for-medicare-beneficiaries-who-need-long-term-care-in-a-nursing-home
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