Nursing Care of the Postmenopausal Woman, 3rd Edition
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INTRODUCTION As a woman ages, her health is affect- ed by biological, social, economic, and psychological influences. It is imperative that the nurse and other healthcare pro- viders assess these factors when a woman presents for care. As a team, these mem- bers can develop an effective plan for the woman before any issues have a serious impact on her well-being. HEALTHCARE INSURANCE AND INCOME A woman who is going through the menopausal transition may begin to think about what the future holds for her. Af- ter retirement, many women live on a fixed income. If a woman does not have a spouse or other partner, her income may be extremely low. Spending money on insurance, copays, and payment for services that are not covered can quickly claim a woman’s monthly income. Medi - care is the main provider of healthcare coverage for older women, and Social Security is the largest source of income (U.S, Department of Health & Human Ser - vices, Centers for Medicare & Medicaid Services, 2022). Out-of-pocket expenses for healthcare can leave the woman ques- tioning whether she will have to choose between her medications or food. Many women may take less medication than prescribed to make it last longer, or they may stop taking certain medications be- cause of cost. Medicare is a health insurance program provided by the government for people age 65 and older. People younger than age 65 are eligible for Medicare if they have certain types of disabilities. Also, people with end-stage renal disease are eligible. There are two main ways to get Medicare- Original Medicare and Medi - care Advantage.
● Original Medicare : This is a fee-for- service health plan that has two parts:
○ Part A is hospital insurance. ○ Part B is medical insurance.
There is a deductible to be paid for both types of Medicare. Once you pay your deductible, Medicare will pay its share. ● Medicare Advantage (also known as Part C): This is a Medicare health plan offered by a private company that contracts with Medicare. These plans include Parts A, B, and usually D (drug coverage). These plans may also cover other benefits that Original Medicaid does not cover. Table 3-1. What to Think about when Considering Medicare Plans ● What are the Medicare plans? ● How do the different plans work? ● What do the different plans cover? ● Do I need a drug coverage plan (Part D)? ● What will my costs be (premiums, deductibles, services, copays, etc.)? ● What is the maximum out-of-pocket for my plan? ● What is the difference between a deductible, coinsurance, copayment, and out-of-pocket? ● What if I have a preexisting condition? ● What if I have end-stage renal disease (ESRD)? ● Do I need any other insurance if I have Medicare? Note . Adapted from Centers for Medicare & Medicaid Services. (2022). Understanding Medicare Advantage Plans. U.S. Department of Health and Human Services https://www.medicare.gov/Pubs/pdf/12026-Understand- ing-Medicare-Advantage-Plans.pdf
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