From Doughnut Holes to Nursing Homes: The US. Healthcare System in Aging, Ethnically Diverse America- MEDC 60803
WORKBOOK 1
Case:
An 87 year old African-American man, Mr Washington, is brought by his family to see you at the outpatient senior center for 3 week history of progressive gait instability and falls at home. You learn he has Medicare Parts A, B and D (no Medigap/supplemental insurance).
PART I:
After a through history and physical exam you suspect multiple causes related to his falls including worsening vision, cervical spondylolosis, diabetic neuropathy and recent change in his medications by a specialist he recently saw. You (team of physician, APN and SW) develop a plan for further work-up with the patient and his family. It includes ordering blood work, MRI of cervical spine, referring him to ophthalmology, sending him to physical therapy for gait training and revising his medication list.
Objective:
1. Understand the basics of Medicare Parts A and B and Medigap Policy.
2. Highlight the strengths and limitations of traditional Medicare Parts A and B.
Tasks: PART I: Using the following resources, answer the following questions on Worksheet 1.
1. What is covered by Part A?
2. What is covered by Part B?
3. What surprises you about what ISN’T covered by Medicare A and B?
4. What is a Medigap policy?
Resources:
1. http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
2. The Basics: Medicare. National Health Policy Forum. January 29, 2007.
PART II:
Mr. Washington wants to know how much the blood work, MRI, ophthalmology appt you have ordered will cost him. Ordered tests:
· CBC, CMP, TSH
· MRI cervical spine
· Ophthalmology New Patient Visit
Objectives:
1. Understand typical hospital charges for common tests and services, what is covered by Medicare and payment responsibilities for patients.
Tasks: PART II
1. Using Worksheet 2, calculate the total charges, what is covered by Medicare Parts A & B, and total patient responsibility.
Resources
1. http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
2. Worksheet 2
PART III:
Mr. Washington has a limited monthly income of $1400 to cover his rent, meals, utilities, medications, transportation and day-to-day costs.
What do you tell the patient?
Objectives:
1. Identify financial struggles older patients on fixed monthly incomes face as they pay their medical bills.
Task: PART III:
1. Explain how you would respond to the patient and family questions about how much these services will cost. How do you think the patient and family will respond? What factors might affect the willingness of the patient and family to discuss these issues with you? What might affect the patient’s willingness to proceed with the recommended workup?
PART IV
Mr. Washington’s daughter asks you if you think it would be cheaper for him to buy a Medigap Supplemental Policy instead of paying all the copays.
Objectives
1. Identify the options for Medigap Supplemental coverage.
2. Complete Worksheet page 2
Compare Mr. Washington’s out-of-pocket expenses:
a. “Bare” = without Medigap coverage, versus
b. By paying a monthly Medicap premium + remaining deductible/copays
3. Thinking about the realities for older Americans with limited income, what often happens to their responsibility for paying deductibles and copays?
4. What impact does this have on hospitals and doctors providing care?
Resources
1. AARP Options re Medigap Insurance
https://www.aarpmedicareplans.com/health-plans/medicare-supplement-plans
You will be asked to give information before you can see specifics.
Enter: Illinois, Zip 60637, DOB 9/3/23, Eligible date 9/1/89
2. Medigap information from CMS, pp1-11. http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf
PART V
His daughter asks you for medication samples because he is out of all his medications, except the diuretic. You discover that for the past 2 months, Mr. Washington is only able to use medication samples because he has been in the Medicare Part D “doughnut hole” and cannot afford his medications. He does not have internet access at home and signed up for a Medicare Part D plan that was the first to mail him an advertisement.
Objective:
1. Understand the basics of Medicare Part D and the strengths, limitations and complexities for older Americans to sign up and participate in this program.
Tasks: Go to Worksheet page 3 to complete the following tasks.
1. Define the “doughnut hole” in respect to Medicare Part D. What was the “doughnut hole” for 2012?
2. Using drugstore.com, tabulate the cost of Mr. Washington’s monthly medication expenses if he did not have a prescription drug plan.
3. Then, utilize the Medicare website to find the cost of patient’s monthly and yearly medication expenses. Figure out what would be the “best” Medicare Part D plan for him. His zip code is 60637.
Resource:
1. Stahlman, ME. “The Nuts and Bolts of PDP’s”. National Health Policy Forum. Issue Brief: 817, November 8, 2006.
2. Drugstore.com: http://www.drugstore.com/
3. Medicare.website to find and compare Part D plans: http://www.medicare.gov/
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