or may not cover medications, or they may cover a portion of the cost. A physician may prescribea generic form of medication as long as it is approved by the insurance company. This may reduce the amount a patient has to pay. If the physician prescribes a medication that the insurance plan does not approve of, the patient may pay out of pocket expenses if they wish to doso. Medicare offers the option to purchase medication coverage as part of Medicare Part A and B,or as a stand-alone option. Medicare provides a list of drugs that are covered under Part D. An individual’s monthly premium will be determined by which category most of the medications come from (Universal American Medicare).2b. Specialists ReferralsJapan’s National Health Insurance plan does not require its members to make appointments or seek referrals if they want to see a specialist. A member may walk into any hospital or clinic for medical treatment and only pay the 30% copay (IHC). United States’ privateinsurance plans may require a referral to see a specialist outside of a primary care physician. In addition, expenses may increase if the specialist is not in-network with the insurance plan. It is up to the individual to contact their insurance plan to inquire about coverage. Some private insurance plans may cover certain specialty requests and deny others (CMMS, referrals). If the individual is on Medicaid Part A and B, they do not need a referral to see a specialist. However, if the individual has any of the 4 insurance plans that fall under Part C of Medicare, they will need a referral. Additional expense may incur if the specialist is out of network (CMMS, specialties and referrals).
TASK 3 C489 62c. Pre-existing ConditionsEvery citizen in japan contributes to the Statutory Health Insurance System and becomes a member of the National Health Insurance program. This means that no one is excluded from having health coverage due to a pre-existing condition. The member is only responsible for paying the 30% copay to receive medical treatment (IHC). The United States passed a law January 1, 2014 that prohibits health insurers from denying or overcharging a patient because of a pre-existing condition. The insurers can no longer establish a limit for medical treatment of the pre-existing condition (DHHS, Pre-existing conditions).A3. Financial ImplicationsAccess to health care and its affordability is a concern all over the world. In 2016, The Common Wealth Fund conducted a survey in several countries to see what percentage of patientsexperienced a barrier to accessing healthcare because of cost. They found that Japan had no such barrier (IHC). Due to the National Health Insurance program that is covered by the government and member premiums, patients do not experience bankruptcy or incur debt due to medical bills. When a family or member cannot afford the excess amount of medical bills in japan, they may apply for various certificates from their region. These certificates allow the government to settle all debt with the member or they may decrease the amount owed to a manageable amount. In the
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- Fall '17
- Task 3 , C806 Task 3