Policy That Guides Community Services for Older Adults - Research Paper Example

Policy that guides community services for older adults due: Introduction Medicare is a principal source of health insurance for the old adults. It enables the elderly to access different health services for treatment, rehabilitation, and treatment. Medicare is influenced by law, for example, it is not allowed by the law to provide benefits for preventive services. The only preventive services allowed are the ones covered through the change in Medicare Act. This paper will discuss a policy that is associated with community services for older adults and their families. In addition, it will highlight the significance, issues, recent and pending actions, and the sufficiency of the policy in satisfying the people’s wants. Facts about Medicare Demographics define people with different social relationships and design needs. According to the 2002 U.S. Census, the older adults constitute 35.6 million that is 12.3% of the country’s population. By 2020, it is foreseen that 17% of the population will be 65 years old and over. The census revealed that 20.8 million women were 65 years old and above, while men were 14.8 million (Anderson, 2011). According to Anderson (2011), the U.S. Census Bureau in 2008, predicted that by 2030, individuals aged 85 years, and above will rise from 4.6 million to 9.6 million (p.6). Medicare is a federal insurance scheme for persons aged 65 years and above. The insurance cover considers those persons with disability. Individuals aged 65 years and above qualify for Medicare benefits and are allowed to apply in part of fully. The other group of individuals who qualify for Medicare are those eligible for social security. One becomes eligible through FICA contributions that occurred during the time he/she was working, or one was married to a person who did. Issues Medicare gives two kinds of insurance that is the traditional fee-for-service option and Medicare advantage. In traditional option, the client is insured by the government while the Medicare advantage is given to individuals who depend on private plan for their benefits. In the traditional option, the Medicare plan is divided into two parts, that is, part A and B. It reflects the division on the funding of the schedule. The part A gets funding from a part of the taxation of social security benefits and payroll taxes. The areas covered by part A include hospice services, some home health care, inpatient hospital care and skilled nursing benefits. On the other hand, part B covers outpatient hospital care, some health care, ambulatory services, physician and associated services. For individuals who qualify for type A receives the services at no cost while part B needs a premium for enrollees and is voluntary. The premium of an elderly beneficiary that enrolls in part B is at 25 per cent of the average costs of the services. The traditional fee-for-service Medicare necessitates that people pay coinsurance and deductibles. The two parts A and B are subject to some kind of coinsurance and deductibles. In comparison, the type A deductible is higher than part B. in addition, there is no limit as per the total amount that a beneficiary should pay, hence, they were responsible for at least 26 per cent of the total costs of Medicare-covered services. Moreover, various services are not included as part of the basic benefits package, for example, dental care and vision. Most of the time, the package given does not include a comprehensive health insurance package because it satisfies only 54 percent of beneficiaries health care expenses (Moon, 2006). Various reforms have been initiated to bring change in the Medicare program. For instance, the DEFRA (Deficit Reduction Act) was intended to make changes in payment of physicians and hospitals. The act specified a certain limit on the rate of increase in the next two years. As well as the Graham Rdman-Hollins Act of 1985 that put in place mandatory deficit minimization target for the following five years. These reforms resulted in cuts in payments to physicians and hospital. In addition, the COBRA (Ominbus Budget Reconciliation Act) of 1985 changed payments under Medicare for health institutions that served a share of poor patients that was not proportional. The hospice care became a component of the program, and the indirect expenses of medical education were modified through PPS (Prospective Payment System) payments rates being frozen. Part of the reforms was directed to enhance the standard and access to care. From this perspective, the difference between the intermediate-care facilities and nursing facilities were removed, and various features created to improve the standard of care in nursing homes. In 1988, the Medicare Catastrophic Coverage Act was passed that involved a large enlargement in Medicare benefits but was a failure. The act encompassed provisions to add coverage for respite care, a cap on out-of-pocket expenses for copayments by the older adults and prescription drugs. The new benefits were to take place in four years and were to be paid by premiums that included income-associated supplemental premium that was charged on enrollees. The act was different from previous policies in the field of social insurance because the benefits were to be financed wholly by the current beneficiaries. The act was revoked in less than eighteen months later because the wealthier elderly individuals refused to pay the additional premiums and income-tax surcharge (McDonough, 2011). Alternatives Supplementary plans The Medigap plans are the other insurances that the elderly purchase to boost their Medicare cover. The health covers assist in settling part of the copayments and drug costs that are necessary for the present framework of Medicare. Supplementary medical insurance (SMI) Supplementary Medical Insurance is a hospital plan that is voluntary where the participants pay premiums that are matched with the government funds. Any individual above 65 years is eligible to enroll in supplementary medical insurance. The program is also referred to as Part B and covers the services provided by surgeons and physicians. In addition, it covers the expenses of health and medical services, for instance, laboratory tests, rental of medical equipment, ambulance transportation, imaging and prosthetic tools. Moreover, it covers some home health services, for example, restricted psychiatric care and in-home visits by a registered nurse. Medicare Advantage Plans The Medicare advantage plans are known as Plan C, and they are provided by private institutions to individuals who qualify. The supplemental benefits comprise of general checkups, wellness, and health programs, hearing, vision and dental. The eligible persons pay an additional premium to Medicare Part B premium. Prescription Drug Coverage The prescription drug coverage is also known as Part D that covers generic and brand-name prescription medicines at engaging pharmacies. The aim of the cover is to safeguard individuals from the high costs of drugs. All Medicare members qualify for this cover regardless of their resources and income, prescription costs and health status. Members who enroll in this cover pay a yearly deductible and a monthly fee. In addition, people pay part of the prescription including co-insurance (Gitman, Joehnk, & Billingsley, 2013). Blue Cross/ Blue Shield Plans The Blue Cross plans are not insurance policies rather; they are prepaid medical and hospital costs plans. The Blue Cross comes into agreement with specific hospitals that agree to give particular hospital services to its members at a specified payment. In addition, the Blue Cross contracts with medical and surgical services. Recommendations The first recommendation is Medicare advantage plan. It is because the beneficiary receives additional non-Medicare benefits and is entitled to minimized cost sharing for Medicare-covered benefits. In addition, the individual is entitled to coverage of items and all services involved in the plan’s benefits package. This is regardless of whether the item or service is covered under FFS Medicare. Moreover, the plan covers services that are excluded from the traditional Medicare. For instance, hearing aids, dental coverage, eyeglasses, and prescriptions. Likewise, the participants do not require Medigap insurance. Furthermore, the paperwork is limited in contract to the traditional Medicare plan. In addition, the Medicare Advantage plan pay additional costs incurred during hospital stays that go beyond the limits set by the established Medicare. The second recommendation is Prescription Drug Coverage because leads to net savings in other Medicare expense. Sufficient prescription drug coverage is critical to the old adults because they account for the biggest part of drug expenditures. Much money is spent in purchasing drugs; therefore, the plan relieves the elderly the burden of expensive drugs. In addition, the individuals can access expensive drugs for better health outcomes. Possible outcomes of recommendations The possible outcome of Medicare advantage plan is that the individual may lack the medical services because the choice of medical facilities and health care providers is restricted. In addition, the participants who travel out of the HMO’s (Health Maintenance Organization) service zone do not obtain the coverage apart from urgent care and emergency situations (Beik, 2013). The possible result of Prescription Drug coverage is adverse drug occurrences. It generally occurs from inappropriate interactions and dosing. The organizations utilizing electronic claims system can be able to recognize and warn the prescribing doctor of the possibility of dangerous interactions of the medicines. In addition, the elderly may be left to take care of high drug expenses from pocket because there is no cover for extreme costs (Wertheimer & Konnor, 2012). Future implications The Medicare reimbursement debates will have future implications to issues associated with health care access. One of the chief issues under discussion is the Medicare prescription drug benefit to assist in eliminating the high cost of prescribed drug for the American old adults. In future under part D of Medicare plan, much money can be saved from therapeutic and generic through generic substitution. The combination of brand-name and generic medicines will reduce the federal government’s expenditure in drug costs. It is because giving care for pharmaceutical products and disables is costly. The rate of disability among the elderly is high and also the mortality rate. With the right funding through Medicare, the rate of disability among the older adults can be minimized through enhanced medical technologies. The other issue under discussion is the proposed ‘give-back’ bill that can cancel authorized cuts in Medicare reimbursement to providers, for example, hospitals, and physicians. The concerns arise from policies by the congress and the (MedPAC) Medicare Payment Advisory Commission. The MedPAC proposes freezing of Medicare payments to home health agencies, physicians, and hospitals. On the other hand, the congress is not willing to pass the Medicare ‘give-back’ or drug benefits bill. As a result, there is an elevated concern about the old adults’ access to health care services as well as prescription. The most appropriate recommendation is to enhance the Medicare. It can be through strengthening and modernizing the organization to upgrade it to modern standards like in the private sector. The Medicare should also accord the same rights to the old adults as is given to the other population. They ought not to be neglected; as they are prone to illnesses because of age. Strengthening the Medicare entails adding benefits such as prescription drugs, more aspects of preventive care, disease management, and chronic care. The outcome is quality health care of the old adults at an affordable price. As a result, the rate of dependency, disability and mortality will reduce (Congress U.S, 2005). Conclusion To sum up this discussion, the health care of the old adults is critical to reduce the rate of death and disability that results from inadequate medical attention. The Medicare is faced with much political influence that limits its ability to fund the necessary procedures. For instance, the lack of the congress to pass the essential bills makes the cost of health care high. On the other hand, the MedPAC proposals to scrap off payments to home health agencies can greatly affect the elderly for they are the beneficiaries of these services. The services that are not covered by the Medicare are crucial for elderly. These services include vision care, routine foot care, long-term care, dental care and hearing aid. Lack of such services deteriorates the health of the elderly. In addition, the old adults may end up depending on others for self-care like in the case of loss of eyesight. Moreover, most of the elderly are at an advanced age and cannot work to earn. The out-of-pocket costs that result from high hospital deductibles, co-payments for a lot of outpatient medical care and annual deductibles for physician’s visit may hinder proper medical attention.   References Anderson, M. A. (2011). Caring for older adults holistically. Philadelphia, Pa: F.A. Davis Co. Beik, J. I. (2013). Health insurance today: A practical approach. St. Louis, Mo: Elsevier. Congress (U.S.). (2005). CONGRESSIONAL RECORD - SENATE. In Congressional Record, V. 147, Pt. 4, March 27, 2001 to April 23 2001 (p. 5270). Government Printing Office. Gitman, L., Joehnk, M., & Billingsley, R. (2013). Personal financial planning. Cengage Learning. Moon, M. (2006). Medicare: A policy primer. Washington, D.C: Urban Institute Press. McDonough, J. E. (2011). Inside National Health Reform. Berkeley: University of California Press. Wertheimer, A. I., & Konnor, D. (2012). Pharmacy Law Desk Reference. Routledge. Read More