Cost and Consumerism Presentation
May 16, 2011
In today’s economy, insurance is not always an option. Below are some scenarios and discussion of out of pocket expenses and options for paying for treatment.
A single, 23 year old female who is generally healthy, is a non-smoker, non-drinker is pregnant and without health insurance. She must find options for paying for prenatal care and delivery of the baby. Option one in the state of Kentucky would be to apply for Medicaid. Under Medicaid eligibility requirements most women will qualify if they meet the poverty guidelines (CMS.gov, 2011 ). If she ...view middle of the document...
His options for paying for surgery and or chemotherapy treatments are as follows:
Option 1: Under the eligibility requirements for Medicaid, he would qualify as medically needy and would be covered for the entire treatment including surgery (CMS.gov, 2011). However, there may be a monthly premium to pay.
Option 2: The local Health Department would work with the University of Kentucky Oncologist to ensure that the patient gets the necessary treatment needed. However, some out of pocket expenses may incur.
If a patient were to pay out of pocket for lung cancer treatment that would include surgery it would be around $40,000 (Surgery.com, 2011) for the surgery and hospital expenses and $3000(Peck, 2009) per chemotherapy treatment with labs included.
Because of the time constraint, the patient would have no choice to pay the fees. So, consumerism would have no factor.
A 10 year old male has discovered he is diabetic. The options for his parents would be to qualify for Medicaid. If the parents do not meet eligibility requirements for Medicaid, they may meet the requirements for KCHIP (Kentucky Children’s Health Insurance Program) where there is a monthly premium that is based on income. Also, the local Health Department is also based on income and has a pharmacy on site where cost of insulin and other diabetic supplies are at a minimal fee. Out of pocket cost could be around $850 per month (Diabetes 360, 2010). As far as consumerism, there are some influences. Some diabetic testing supplies are now offered over the counter, which, if paid out of pocket, will save money. The best thing for a diabetic is education. Learning how to eat right, exercise, and keep close track of their own blood sugar is the key to keeping their cost down.
A 60 year old female, who has chronic arthritis, but has no insurance, is seeking options. In this situation the options are limited. She does not qualify for Medicaid because her condition is not deemed medically needy and she is not old enough to qualify for Medicare. Treatments may include surgery, physical therapies and expensive...