Patient Simulation And The Importance Of Health Literacy

Today, there are many issues regarding health insurance and the policies available. In the United States, this issue is becoming more prominent. Most Americans will choose a health care plan that is most ethical for their lifestyle. Whether you are a 22-year-old recent college graduate, a newly married 30-year-old couple planning to begin your family journey, or a retired professional; choosing a health care plan is an extremely important decision. It can provide peace of mind with preventative measures and the necessary medical actions required. Many people make uneducated decisions before taking the time to research the important information that play a fundamental role within each different health care plan. Even just a basic comprehensive understanding of the health care plan you choose will allow you to spend your money wisely and maximize the benefits you will receive.

As we begin to age, health care plan decisions become even more crucial than once before. We acquire more medical attention because our bodies are not as healthy as before. The older community should be considered a priority in health care plans. Medicare plans seem to be elevating the quality and cost of care while accomplishing the needs of our older generations as a whole. For example Walt, a 66 year old male, was diagnosed with coronary heart disease.

Coronary heart disease is when plaque begins to build up overtime inside the coronary arteries often leading to reduced oxygen-rich blood flow to the heart. Coronary heart disease can cause heart attacks as these patients are prone to angina, chest pain caused by reduced blood flow to the heart and even other forms of heart disease. Some symptoms patients with coronary heart disease suffer are: discomfort to the center of their chest, pain and intense pressure, tingling to some body parts, and constant feeling shortness of breath. Things like stress, diet, lifestyle, and cholesterol can be contributing factors to coronary heart disease. Walt is a retired high school principal from Denver, Colorado and based on his professional responsibilities and workload, stress is likely a key factor leading to his heart disease risk. Since Walt is above the age of 65, he qualifies for Medicare health insurance plans. This eligibility decidedly assists him financially since he is retired and has countless health issues and expenses.

The plan that best suits Walt’s lifestyle is the Medicare Advantage Plan: Anthem MediBlue Plus (HMO) through Anthem Blue Cross and Blue Shield Insurance. This is a nationwide covered plan. Although Walt resides in Denver, Colorado, he is still eligible for this health care plan. The premium for this plan, (the amount he will pay monthly for this policy) is $0 due to the fact that he is retired. The deductible or amount personally paid before insurance pays for this health plan is $0 and the drug deductible is $0 as well. With this plan, Walt will pay a small fee of $3. 35 when he needs prescription refills due to the catastrophic coverage of this health plan. Lastly, the out-of-pocket maximum (the total amount Walt will need to pay for health care services in a year before his plans pays 100%) is $4, 300, which is quite pricey. On Medicare. gov, this plan has an overall rating of 4 out of 5. With his health status, this is an appropriate plan for Walt because he will be taking prescription drugs like Statins to maintain coronary heart disease risks. Statins, also called HMG-CoA reductase inhibitors, are drugs prescribed to heart disease patients in order to lower cholesterol levels, which also lowers risk of heart attacks and strokes; Statins have been proven to lower the risk of heart attacks and strokes up to 35%.

Patients with heart diseases like Walt need to see Cardiologists. A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels. These specialists are able to perform the necessary acts like x ray imaging on the patient’s heart or electrocardiograms to detect any unusual electrical activity within the heart. With Walt’s medical insurance coverage, he is able to see the necessary people relating to his disease. Along with Cardiologists, Walt could visit with his Primary care provider, specific physicians if complications were to arise (cardiovascular surgeon, neurologists, etc. ), a cardiac rehabilitation team (like dieticians and exercise therapists) to make lifestyle changes, and mental health professionals to help cope with psychological aspects of the disease.

Cardiovascular diseases cause about 18 million deaths per year. This is a barrier people face because there is little knowledge about the risk factors leading up to this disease and little to no preventative care acts aiming to enhance understanding of heart diseases. According to the journal Circulation published by the American Heart Association, health literacy is essential in order to use medication effectively and improve our heart-healthy behaviors; but it is so limited in America that majority of people do not even recognize abnormal blood pressure readings. High blood pressure can put a strain on your heart and if people do not begin to realize when their blood pressure levels raise above a normal rate, more and more people will suffer from cardiovascular diseases before they know it. This is a barrier, and as a population we need to be more educated about our health.

If Walt were to go see his Specialist, he would pay a $40 copay fee per visit, and $0 per visit to his Primary doctor. Any treatments needed, such as: tests, procedures, or x rays would cost him anywhere from $0-$50 per service. If diagnostic radiology services like ECG or MRI’s were needed, it would be more expensive and cost him about $260-300. For example, if Walt were to see his Specialist, costing him $40, and the doctor referred him somewhere to get an ECG done to test his heart’s electrical activity; Walt would spend a total of $300-$340 for that procedure and visit. Another diagnostic test Walt could experience could be a Cardiac Catheterization test, inserting a catheter into an artery to observe abnormalities or blockage of the coronary arteries (Wexner Medical Center). Being a patient suffering coronary heart disease, he is at risk for episodes like heart attacks, stroke, and heart failure. If Walt were to experience a heart attack, he would undergo symptoms like chest pain/ pressure, uncomfortable upper body pain, rapid heartbeat, discomfort in his stomach, shortness of breath, dizziness, and cold sweats. After these symptoms lasted for a period of time, Walt would need to call 9-1-1 to get to a hospital; which he has emergency coverage for.

The Affordable Care Act, ACA, benefits patients like Walt diagnosed with various heart diseases. According to the Affordable Care Act, people who are at risk or have any heart diseases have many protections like: you are unable to be dropped from your plan, you may not be turned down for coverage, and you cannot be charged extra due to your health status. The Affordable Care Act also provides many aspects to reduce the cost you have to spend out of pocket: your plan cannot have limits on your dollar benefits, your out-of-pocket maximums will be limited, and there are financial aid options to lower costs. Furthermore, under the ACA, drug coverage has additional savings for heart disease patients. Through the doughnut hole, or Medicare gap, you are not required to pay full price for your prescription drugs. For example, Walt takes a Statin called Atorvastatin. This prescription drug fill would cost a normal patient over $300. But with all of the added benefits Walt receives, he is only responsible to pay a fraction of that cost totaling his prescription drug expenses to just $3. 35 per refill.

For all of the reasons stated above, this Medicare Advantage Plan along with the Affordable Care Act provide many benefits to patients like Walt to enjoy and ensure the best affordable health care during his retirement years.