Ethical Dilemmas and Concerns Regarding Medicare in Healthcare Management

According to the U.S Department of Health and Human Services, the Affordable care Act from President Obama gives consumers more options and benefits when seeking coverage from insurance company. It offers lowering cost as well as gets more access to high quality of care. This law creates Patient’s Bill of Rights that is very effective to protect consumers from any abuses or fraud from insurance company. Some preventive services are available to many Americans especially Medicare recipients at no cost. Not just that, they also receive a special offer of 50 percent discount for any well-known drugs in the market place under Medicare named “donut hole.” The Affordable Care Act helps other organizations and programs to convince healthcare providers

Medicare part A is hospital coverage for inpatient hospital stays. More specifically, Part A is coverage for critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. Part A also covers inpatient care in a skilled nursing facility (not supervisory or long-term care), hospice care services and some home health care services. Inpatient care in a Religious Nonmedical Health Care Institution is also covered. In the scenario provided, Mrs. Zwick is admitted to the hospital as an inpatient because she had a stroke. The patient was deemed by the physician to need continued treatment after discharge due to the patient 's condition and was discharged to a skilled nursing facility.

Medicare Part A is otherwise called the Hospital Insurance and covers up to 100 days of the Skilled Nursing Facility stay. To be qualified for it the patient first has to have been hospitalized for more than 3 days in a hospital (qualifying hospital stay) so the stay in it would not be considered outpatient. After the hospital stay the doctor that followed the patient in the hospital or the PCP that releases the patient from the hospital needs to write the order for the SNF services. In order for a patient to receive the services from the SNF they have to:

Medicare Part D is the prescription drug plan. There are various options under this portion of Medicare and depending on the one that your mother has chosen would base the amount of coverage that she would receive for prescription medications. This does not necessarily cover the full cost of the prescription medications; there are deductibles and copayments that must be met.

Part A covers hospitalization, emergency hospitalization, subacute care, home health, and end of life care depending on the situation. Part B covers Doctors’ visits, and covers subacute, end of life, and in home care that Part A will not cover if the patient qualifies. While part C covers medications and needed medical equipment (Center for Medicare and Medicaid Services, 2014). What Medicaid pays for depends on what state you live in, and what your specific situation is. Universally Medicaid covers hospitalization, day procedures, doctors’ visits, nursing facilities, home care, child health check, nurse practitioners, and transportation to doctors’ visits (Medicaid.gov, n.d). Medicaid offers different services in each state, but the aforementioned are the mandatory areas of coverage for every state. Medicare is aimed at helping the older population, while Medicaid is aimed at people in every stage of life. But who exactly is covered under which

The Medicare offers three types of insurance coverage. Medicare part A hospital insurance covers inpatient care in hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. This coverage does not cover custodial or long-term care (Center for Medicare and Medicaid Services, 2013). Medicare also offers part B Medical insurance that covers preventative care and outpatient care. Prescription drug

Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private

Medicare provides access to health insurance coverage for more than 45 million people who qualify due to disability or age. The three components of Medicare are Parts A, B, and D. Part A is hospital insurance and provides coverage for inpatient hospital services, skilled nursing facility services, hospice services, and post-institutional home health care. Covered services under Part B one component of supplementary medical insurance (SMI) include physician services, durable medical equipment, laboratory services, outpatient hospital services, physician-administered drugs, dialysis, and certain other home health care services. The other component of SMI, Part D, mainly provides access to prescription drug coverage through private insurance plans.

Medicare part A is referred to hospital insurance and part B is medical insurance. What part A Medicare does is it covers the inpatient in hospital care. This Medicare is available to the people who have worked about ten years and also paid their Medicare taxes while working. The benefits part A Medicare has is they do not have to pay monthly premium to receive care. Part A Medicare does not cover for everything you will have to pay half of it. With this you also have to pay the deductible fees and then Medicare will cover for the rest you have left to pay off. Medicare part B covers some of the non-hospital expenses. In this insurance you have to also pay the monthly premium and if you have a high income the fee will be more.

Medicare, as nationwide social insurance passed into law as title XVII of the Social Security Act of 1965, currently using about 40 private insurance companies across the United States. The primarily purpose of Medicare was to provide financial support to elderly age sixty-five and older or younger people with a permanent disabilities. There are four different parts of Medicare plans to select from: “Part A provides hospital and skilled nursing coverage’s through Hospital Insurance Trust Funds. Part B covers physician services, ambulatory surgical services, and other miscellaneous services paid by Medicare beneficiaries. Part C is managed care coverage offered by private insurance companies. It can be selected in lieu of Part A and B). Medicare Part D covers

Parts A and B are apart of the “Original Medicare”. Meaning care that is managed by the federal government. Part A of Medicare is hospital insurance. This covers hospital care such as inpatient care, hospice care, home health care services, and nursing care facilities. Generally free of charge if the beneficiary has worked and paid Medicare taxes for at least 10 years. If not a monthly premium is established. Typically, part A doesn’t cover the whole hospital bill. For at least 60 days Medicare will pay for 100% of the hospital stay charges or 100% of 20 days at a skilled nursing facility, and after that a flat rate amount is paid up to the maximum number of covered days.

In 1965, President Johnson signed Title XIX of the Social Security Amendments, which enacted Medicare and Medicaid (CMS, n.d.). Originally, Medicare was composed of Part A and Part B. Part A is covers more medical costs associated with hospital stays, while Part B cover medical costs such as durable medical equipment, nebulizers, some vaccinations (Pneumovax ®, Zostavax ®, and Flu), and some nebulized breathing treatments. The original program was designed to cover disabled individuals and every over the age of 65.

Part A – This is the hospital insurance portion of Medicare. It comes at no cost to you once you turn 65.

It is important that we act in a way that is ethical, legal, and commendable. Medical professionals struggle with healthcare dilemmas that are not experienced by the general public. Medical-ethical decisions have become increasingly complicated with the advancement of medical science and technology. (Fremgen) Just like the government has laws for citizens, not having laws in healthcare would allow people to do anything they want. It is important that we study the ethics and laws of healthcare, because if we were put in a situation it is essential that we know the difference between right and wrong. In the article I found, it talks about a nurse who refuses to give CPR to an older woman who collapsed in a senior residence where she works. This article has many more ethical issues than legal issues.

Everyday, healthcare professionals are faced with ethical dilemmas in their workplace. These ethical dilemmas need to be addressed in order to provide the best care for the patient. Healthcare professionals have to weigh their own personal beliefs, professional beliefs, ethical understandings, and several other factors to decide what the best care for their patient might be. This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brains hemispheres which has left her unconscious. She only has some brain stem reflexes and requires a ventilator for support. She is unable to communicate how she wishes to proceed with her healthcare. Mrs. Smith’s children, Sara and Frank have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life, as Sara would like to do, or stop all treatments and care, as Frank feels his mother would want. In the healthcare field, there are situations similar to this case that happen daily where moral and ethical judgment is necessary to guide the decision that would be best for the patient. The purpose of this paper is to explore and discuss, compare and contrast the personal and professional values, ethical principles, and legal issues regarding Mrs. Smith’s quality of life and further plan of care.