The program presents a standard head-to-toe screening assessment appropriate to inpatient, emergency, and clinical settings. It provides the viewer with an example of how facets of the more detailed assessments provided in the systems-based programs are drawn together into an exam appropriate for an initial contact, and how this type of exam can assist in learning of health issues that need focused attention. This program is the thirteenth in a part series that provides an overview of the patient assessment process, and how it correlates with quality patient care. After viewing this program, the learner should be able to:
August October 1 There is also a "general enrollment period" which occurs in the first three months of each year. An individual who fails to enroll during his initial period of eligibility can only enroll in Part B of Medicare during this general period and may be required to pay a premium surcharge for late enrollmentunless he falls under the provisions of the working elderly discussed below.
Enrollment in Part A can take place at any time and coverage can be retroactive up to six months unless the individual must purchase Part A coverage. If an individual must purchase coverage, enrollment in Part A can only occur during the initial or general enrollment period and coverage will begin on July 1 of that year.
Similarly, for beneficiaries enrolling in the general enrollment period Part B coverage will not begin until July 1 of that year. Enrollment is generally handled by the Social Security Administration through their Summary of nursing basics offices. Railroad Retirement Summary of nursing basics should contact the Railroad Retirement Board to enroll.
As ofyou may also enroll online at www. The application process can take less than 10 minutes. Working Elderly At the time that the Medicare program was established in most people retired at 65, and automatically began their participation in the program at that age.
However, as people began to work past the age of 65, and as Medicare began to try to contain costs, Medicare coverage and enrollment policy changed. In the early 's several pieces of legislation were passed which made Medicare benefits secondary to benefits payable under an employer group health plan EGHP for employees and their spouses age 65 and older.
Further, employers are now prohibited from offering a different health plan to Medicare eligible employees and their spouses than that which is offered to other employees. Employers with less than 20 employees are exempt from these new laws but may participate voluntarily.
These changes led to the establishment of an additional "special enrollment period" for the working elderly. Individuals, over the age of 65, who are covered by an EGHP by virtue of their own, or a spouses' employment, have the option to enroll in Medicare past age 65 without incurring a premium surcharge.
Since their EGHP is the primary payer many workers may not want to pay for Medicare coverage which might be duplicative. Failure to enroll during this "special enrollment period" may result in a premium surcharge and the individual may not be allowed to enroll until the next general enrollment period.
Originally, the special enrollment period SEP began on the first day of the first month in which the employee was no longer covered by the EGHP, and ended seven months later.
Additionally, the period during which enrollment may occur, after EGHP coverage ends, was extended from seven to eight months. M attained age 65 inbut continued to work and be covered by an EGHP. In April she filed an application for monthly Social Security benefits and Medicare because she planned to retire on June 30, She can elect to have Medicare coverage begin either in April ofor in any of the three following months.
She elects to have coverage begin in July ofsince she has coverage under her EGHP until that time. Mary could also have chosen to delay her application for Medicare until Julythe first full month she was not covered by an EGHP.
This would also result in Medicare coverage becoming effective on July 1,the first day of the month that she was no longer covered by the EGHP. M have delayed application for Medicare until Augusther coverage would not have been effective until September of This is because enrollment in Medicare during the seven months following the first full month in which an individual is no longer covered by an EGHP will result in coverage beginning the first day of the month after the month of enrollment.
Therefore, to avoid any gaps in coverage it is advisable to enroll either in the three months before, or in the actual month your employment ends. It is important to remember that the changes in the law did not alter the fact that the SEP is only available to people covered by an EGHP by virtue or their own or a spouse's employment.
Failure to Enroll There can be serious implication for individuals who fail to enroll in Medicare during their proper enrollment period.
What can be more serious, is that failure to enroll during the initial or special enrollment period will result in the individual not being allowed to enroll in Medicare Part B until the general enrollment period during the first three months of each year.
Coverage for Part B benefits then would not begin until July of that year. As a result, there may be several months when an individual, having no Part B Medicare coverage, may be vulnerable to costly out-of-pocket medical expenses. It is important to note that an individual entitled to Social Security or Railroad Retirement benefits may enroll in Part A at any time and receive up to 6 months retroactive coverage without penalty.
It is only Part B coverage which is subject to enrollment period restrictions and to a surcharge. An exception to this is those individuals not entitled to Part A coverage but who elect to pay the premium and participate voluntarily. They will be subject to the enrollment restrictions and the surcharge.
Appeals A decision to deny Medicare eligibility or coverage, for whatever reason, can be appealed to the Social Security Administration or Railroad Retirement Board. When a person's enrollment rights have been prejudiced because of the action, inaction, misrepresentation or error on the part of the federal government she cannot be penalized or caused hardship.Flashcards created for the book Fundamentals of Nursing.
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For more information, please consult the Publication . Funding for the National Guideline Clearinghouse (NGC) has ended. Learn more about the status of the site. This is a summary of key elements of the Security Rule including who is covered, what information is protected, and what safeguards must be in place to ensure appropriate protection of electronic protected health information.
Course Summary Use this course to refresh your memory about the fundamentals of nursing. Our chapters can act as supplemental reading for your nursing textbook, help you prepare for an exam or.