A 65-year-old man is being evaluated by the internal medicine service prior to discharge from the hospital. He was admitted 2 days ago with decompensated heart failure with reduced ejection fraction and has responded well to treatment. He has a history of chronic hepatitis C and chronic obstructive pulmonary disease. The patient continues to smoke a pack of cigarettes a day but is trying to quit. He does not drink alcohol. He recently retired and enrolled in Medicare part A, which he expects to cover his hospital stay. However, the patient is concerned about the cost of the medications that will be needed to manage his chronic conditions. Which of the following health insurance programs should be recommended for this patient?

Question

A 65-year-old man is being evaluated by the internal medicine service prior to discharge from the hospital.  He was admitted 2 days ago with decompensated heart failure with reduced ejection fraction and has responded well to treatment.  He has a history of chronic hepatitis C and chronic obstructive pulmonary disease.  The patient continues to smoke a pack of cigarettes a day but is trying to quit.  He does not drink alcohol.  He recently retired and enrolled in Medicare part A, which he expects to cover his hospital stay.  However, the patient is concerned about the cost of the medications that will be needed to manage his chronic conditions.  Which of the following health insurance programs should be recommended for this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1e6_a024_8f63_85660bca89fe_MD0005_00 Medicare is a program administered by the federal Centers for Medicare and Medicaid Services (CMS) to provide health insurance coverage for older Americans. Eligible enrollees include those age 65 and older, as well as those with permanent disability, end-stage renal disease, and certain neurodegenerative disorders (eg, amyotrophic lateral sclerosis). The program is subdivided into parts A, B, C, and D, and enrollees may choose which parts they wish to participate in (subject to monthly premiums, copays, and deductibles). Most Medicare enrollees participate in part A, which covers inpatient hospital services. Most will also choose to participate in part B, which covers outpatient services (eg, laboratory tests, x-rays, doctor visits) and preventive care. However, prescription drug coverage is not included in part A or B. Therefore, enrollees may choose to either pay for their own prescription drugs or enroll in a part D plan. Part D plans are administered through contracts with private insurers and are subject to separate (means-tested) premiums. (Choice A) COBRA (Consolidated Omnibus Budget Reconciliation Act) is a legal framework in which patients who have left their employer may continue to receive benefits on their previous employer's group health insurance. The benefits are provided for a limited period under certain circumstances (eg, transition between jobs, death, or divorce). (Choice B) Medicare Advantage plans are privately contracted insurance plans that are collectively known as part C. These plans provide inpatient and outpatient services as an alternative to parts A and B. Enrollees are restricted to a limited provider network but benefit from lower out-of-pocket costs and additional value-added services (eg, quality improvement programs). (Choice D) Dual eligible enrollees (also known as Medicare-Medicaid or "Medi-Medi") are very low income seniors or disabled individuals who qualify for both standard Medicare and Medicaid benefits. (Choice E) Medigap (Medicare supplement insurance) plans are optional supplemental plans that cover copays, deductibles, and other services not covered by parts A and B; they do not cover medications. Educational objective: Medicare part A covers primarily inpatient services. Part B covers outpatient services. Part C (Medicare Advantage) allows enrollment in private insurance plans. Part D covers prescription drugs. References: The effect of the Medicare Part D prescription benefit on drug utilization and expenditures (http://www.ncbi.nlm.nih.gov/pubmed/18180465)

A 65-Year-Old Man Is Being Evaluated by the Internal Medicine