Analysis on the Importance of Crafting Medicare Plans and Effects on Benefits Accrued by the Patient

Analysis on the Importance of Crafting Medicare Plans and Effects on Benefits Accrued by the Patient

Introduction

            Many governments around the world have made attempts of going to the drawing board and crafting Medicare plans. The aim of the Medicare plans is to provide medical services to the patients at highly subsidised prices Kohler & Baghdadi-Sabeti (2005). Majority of the beneficiaries of Medicare plans are the vulnerable groups in the population. The vulnerable groups in the population are the poor, the disabled, the elderly and minority ethnic groups (Shi & Singh, 2014). The cost of healthcare is high and sometimes patients may call for specialized healthcare which may be beyond their reach. Medicare has proved to be a financial burden to many governments around the world, however they still have to support the vulnerable groups. The middle class population has stepped away from government supported Medicare programs to private healthcare which is still tinged with bureaucracy (Pear, 2007). This paper discusses the significance of Medicare plans and how it affects the benefits accrued by the patients.

            In the zip code 20874, there are exactly three drug plans namely Prescription Drug Plans, Medicare Health Plans with Drug Coverage and Medicare Health Plans without Drug Plans. In the Prescription Drug Plans, patients are only entitled to prescription drugs when they fall ill. Additionally, the patients do not receive any medical attention under the plan. The patients get access to prescription drugs as soon as they receive treatment from their doctors. In the Medicare Health Plans with Drug Plans, patients are entitled to the medical attention they require whether specialized attention or general treatment. Moreover, they get receive medicine under the program. Both the drugs prescribed and medical attention given is covered under the Medicare program. This plan ensures all the costs involved in treating the patient are covered by the Medicare and the patient benefits fully from this arrangement without having to fork out extra charges for their health treatment (Medicare, 2015).

            In Medicare Health Plans without Drug Plans, patients are only entitled to medical attention while they are required to spend extra money for their drugs (medicine). This research will analyse two pharmacies under the American Medicare Plan. They include Express Scripts and SilverScript Insurance Company which operates a number of pharmacies. Express Scripts is one of the largest pharmaceutical corporations in the United States of America Davidson & Greblov (2005).

  Express Scripts SmartD Rx Saver (PDP) (S0064-005-0) SilverScript Insurance Company SilverScript Choice (PDP) (S5601-010-0)
Estimated Annual Cost $1,519 $1,680
Monthly Premium $28.60 $26.00
Annual Drug Deductible $320 $0
Total Annual Premiums Paid $343.20 $312
(Annual Premiums – Annual Drug Deductible) $23.20 $312
     
     

            Under the Prescription Drug Plan, the estimated annual costs for Express Scripts Medicare Plan is a lower than the Medicare Plan for SilverScript Insurance Company. Express Scripts pharmacy offers cheaper medication compared to SilverScript. The lowest monthly premium is offered by SilverScript Insurance Company at twenty six US dollars in comparison with Express Scripts’ offered at twenty eight US dollars and sixty cents. When computed on an annual basis a patient under the Express Script Medicare Plan pays a total of three hundred and forty three US dollars and twenty cents, while a patient under the SilverScript Medicare Plan pays a total of three hundred and twelve US dollars (Medicare, 2015). In contrast, SilverScript’s Medicare Plan in terms of premiums is relatively cheaper than Express Scripts’. Furthermore, Medicare Plans are cheaper than plans involving the patient to pay at retail prices.

            Express Script Medicare Plan offers an annual drug deductible of three hundred and twenty US dollars while the SilverScript Medicare Plan offers no cost. When the drug deductible costs are included in total costs, patients under Express Script’s Medicare Plan pay a less amount of twenty three US dollars and twenty cents. Patients under SilverScript Medicare Plan, still incur the same premium costs of three hundred and twelve US dollars. Hence the Express Script’s Medicare Plan is cheaper compared to SilverScript’s Medicare Plan (Medicare, 2015). The best pharmacy for the patients is Express Script as it allows them to redeem their drug money if on that year was not put under any medication. This makes it flexible for the patients to operate with.

            According to inhousepharmacy.biz (2015), the price of drugs is relatively lower in India compared to the United States of America. India is a big player in global pharmaceutical industry and has some of the greatest pharmaceutical companies in the world Davidson & Greblov (2005). India has a high number of highly educated scientists. Furthermore, India is the biggest manufacturer in the world of generic drugs. All these factors ranks India highly in the field of the biggest drug producers in the world enabling them to produce relatively cheaper drugs.

            Medicare Plan D offers great incentives to the patient in terms of payments paid hence it is very cheap and affordable compare with retail purchase without Medicare D. Medicare Plan D gives the patients access to cheap and medical care. They are guaranteed access to drugs while under medication and are given a priority on the choice of the doctors. The patients can access drugs on a 24/7 basis from a pharmacist that is within their reach or through mail orders. The greatest disadvantage is that patients can continuously pay premiums without falling sick and they might feel a pinch in their purse strings Pear (2007). Medicare Plans also require great resources for them to be implemented in a way that is beneficial to the patients.

Teaching Plan

            The patient should ensure he or she meets the threshold for him or her to be registered under the Medicare Plan D. The patient should possess all the necessary government documentation such as the relevant copies of IDs and certificates. The patient must also choose the plans being offered wisely. He or she should understand how he/she engages with the various companies offering Medicare Plans. There must be proper communication between the patient and the respective company. The patient should also be flexible as the companies at times may change their plans and rules of engagement. The patient stands to benefit a lot of challenges such full time access to his or her choice of doctor. Patients can access cheap and affordable healthcare. Such healthcare services are offered at an incentive. Such benefits can also be extended to the whole family and is covered in case of any emergencies arising. The greatest disadvantage of the Medicare Plan is that it may be cumbersome and tedious to receive and process payments.

Conclusion

            The patients should undertake Medicare Plans crafted by the government seriously since they play a great role in reducing the costs of healthcare services. These helps them to eliminate financial burdens in their lives. Further research should be conducted to study who is the final beneficiary of the Medicare Plan: the corporations, the patients or the government. The government should also introduce rules and regulations for private healthcare which still proves challenging for the patients besides it being full of promises.

References

Davidson, L., & Greblov, G. (2005). The pharmaceutical industry in the global economy.

Article prepared for the Indiana Economic Development Corporation. Indiana

University Kelley School of Business.

Inhousepharmacy.biz (2015). Retrieved from https://www.inhousepharmacy.vu/default.aspx

Kohler, J. C., & Baghdadi-Sabeti, G. (2011). The World Medicines Situation 2011. World

Health Organization.[Links].

Medicare.gov (2015). Retrieved from http://www.medicare.gov/

Pear, R. (2007). Medicare Audits Show Problems in Private Plans. The New York Times.

Shi, L., & Singh, D. A. (2014). Delivering health care in America. Jones & Bartlett Learning.