30 - Economics of Health Care in Later Life Flashcards
An older adult is concerned that if her spouse, who recently suffered a stroke, is placed in a nursing home, “they will take everything in order to pay for his care.” What response will the nurse make?
a. ) “A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property”
b. ) “You should consider transferring the assets to your son so that your husband will qualify for Medicaid”
c. ) “Have you considered caring for your husband at home since Medicare will cover custodial care at home?”
d. ) “Are you aware that your children have a legal obligation to provide financial support toward the care of disabled parents?”
a.) “A spouse is allowed to keep a percentage of the family income and cash as well as the family home, car, and personal property”
The spouse is permitted to keep a portion of the assets, home, car, and personal property. There is a “look back” period of 36 months to determine whether funds that were transferred would normally have been available to the individual.
Medicare does not cover the cost of custodial care; it covers skilled care only. There is no legal obligation of a child to support a parent.
The cost of nursing home care is significant. The primary payer for nursing home care is:
a. ) Medicare.
b. ) Medicaid and private pay.
c. ) Long-term care insurance.
d. ) Medigap insurance.
b.) Medicaid and private pay.
The primary payers for nursing home care are Medicaid and private pay.
Because of the potentially high co-payments associated with Medicare, persons who are able to do so often purchase supplemental insurance plans. These feature standard benefits and generally several different policies are available from which to select in each state.
Plans referred to as Medigap cover only the deductibles and part of the coinsurance amounts based on Medicare-approved amounts contracted with providers.
Long term care insurance does pay for nursing home, but the primary payers are Medicaid and private pay.
When educating an older adult about Medicare Part D, which information will be included? (Select all that apply.)
a. ) It is an elective prescription drug plan with associated out-of-pocket premiums.
b. ) All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan.
c. ) The plan covers all costs of drugs after a deductible is paid.
d. ) The plan is not available for individuals who are receive both Medicaid and Medicare.
e. ) This prescription drug plan requires client co-payments.
a, b, e
a.) It is an elective prescription drug plan with associated out-of-pocket premiums.
b.) All persons with either Medicare Part A or B can voluntarily purchase a Medicare Part D prescription drug plan.
e.) This prescription drug plan requires client co-payments.
An individual with Medicare Part D prescription drug coverage pays a deductible and co- payments.
The other options represent inaccurate information regarding Medicare Part D.
When an older adult is considering long-term care insurance (LTCI), what is important for the nurse to encourage the client to consider?
a. ) The older one is when applying, the lower the rates will be
b. ) It is financially better to avoid purchasing LTCI through a group policy
c. ) It is wise to scrutinize all exclusions before enrolling
d. ) All policies cover care at home as well as in a long-term care facility
c.) It is wise to scrutinize all exclusions before enrolling
LTCI policies vary, and many have exclusions for specific diseases, for example, Alzheimer’s disease. It is prudent to examine the policy before purchasing.
Costs increase as one ages. The best plans are those that are negotiated by a large group such as an employer, state organization, or association.
Although policies are becoming more creative, they are traditionally limited to care in a long-term care facility and frequently do not cover care in the home.
A 70-year-old diabetic patient has just received instruction from a nurse on glucose self- monitoring. He tells the nurse: “I hear that those test strips cost a lot. I am not sure that I can afford anything else. The only health insurance I have is Medicare Parts A and B.” The best response by the nurse is:
a. ) “I am sorry, but Medicaid is the only insurance that covers the cost of diabetic testing supplies.”
b. ) “Medicare Part A will cover the cost of the supplies to manage your diabetes.”
c. ) “Medicare Part B will cover the cost of the supplies to manage your diabetes.”
d. ) “I am sorry, but Medigap insurance is the only insurance that covers the cost of diabetic testing supplies.”
b.) “Medicare Part A will cover the cost of the supplies to manage your diabetes.”
Medicare Part B covers the cost of diabetic testing supplies.
A Navy war veteran is seeking advice about getting treatment for a chronic respiratory problem at the local veterans’ hospital. The nurse’s initial response is to ask:
a. ) “Why aren’t you considering the local general hospital for the care that you need?”
b. ) “Are you willing to travel to a veterans’ hospital that offers respiratory diagnostic services?”
c. ) “Have you ever been treated at a veterans’ hospital before?”
d. ) “Is the problem related to something that occurred while you were in the Navy?”
d.) “Is the problem related to something that occurred while you were in the Navy?”
Instead of coverage of any health problems, priorities were set for those problems that were in some way deemed “service connected”; in other words, the health care problem had to be linked to the time the person was on active duty.
While the other questions are not inappropriate, they do not address the issue of whether the client is illegible for care at a veterans’ hospital.
The original intent of Social Security was to:
a. ) provide a hospital insurance plan.
b. ) minimize the dependency of older members on younger members of society.
c. ) provide the blind, older adult, or disabled with adequate financial support.
d. ) penalize women financially for numerous zero wage years while raising children.
b.) minimize the dependency of older members on younger members of society.
The original intent of Social Security was to minimize the dependency of older members of society on younger members.
Social Security is not a health insurance plan. It was designed to provide monetary support to persons at a certain age or when blind or disabled.
It was not intended to meet all financial needs of the individual.
Benefits are provided to individuals who worked or are married to someone who worked the number of years required.
A 70-year-old person who has Medicare Part A only is discussing the cost of health care with a nurse. The nurse understands that Medicare Part A covers the cost of which of the following? (Select all that apply.)
a. ) Diabetic testing supplies
b. ) Acute hospitalization semiprivate rooms
c. ) Intensive care unit hospitalization
d. ) Skilled rehabilitative nursing care in a health care facility
e. ) Prescription medications
b, c, d
b.) Acute hospitalization semiprivate rooms
c.) Intensive care unit hospitalization
d.) Skilled rehabilitative nursing care in a health care facility
Medicare Part A covers the cost of acute hospitalization semiprivate rooms and any necessary medical services and supplies, which include intensive care unit costs.
It covers the costs of skilled rehabilitative nursing care in a health care facility.
The first 20 days are covered at 100%, days 21 to 100 with a daily co-pay of over $10, and there is no coverage after 100 days.
Diabetic testing supplies are covered under Medicare Part B and prescription medications are covered under Medicare Part D.
An older adult asks a nurse, “I saw an advertisement and went to a free breakfast to hear about Medicare Advantage Plans. They sound really good, but I am not sure. Are there benefits to joining one?” The nurse relies on which of the following information when formulating a response? (Select all that apply.)
a. ) All Medicare advantage plans have prescription drug coverage.
b. ) Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B.
c. ) There are no deductibles in Medicare Advantage plans.
d. ) Medicare advantage plans may provide a cost savings to the member.
e. ) Members must obtain a referral to see a specialist from an assigned primary care provider.
b, d, e
b.) Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B.
d.) Medicare advantage plans may provide a cost savings to the member.
e.) Members must obtain a referral to see a specialist from an assigned primary care provider.
Medicare Advantage Plans (MAPs), or Medicare Part C, use a prospective payment system and includes traditional health maintenance organizations (HMOs) and other managed care plans.
All traditional services covered by Medicare Parts A and B must be provided, and additional services, co-pays, and deductibles are predetermined. Medicare Advantage Plans may or may not provide prescription drug benefits.
MAPs may provide a cost savings to the member as well as extra benefits. However, special rules must be followed, including the requirement that no care is obtained without a referral from an assigned primary care provider.
