Understanding Insurance as New Grad

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Hello Everyone!

I will be graduating in 16 days (but who's counting?) and am excited to start my career as an RN. One topic in particular has me confused and I was wondering if someone would be kind enough to point me in the right direction. The topic of insurance (medicare, medicaid, etc.) was briefly covered in nursing school and I was interested in finding out more for the sake of my future patients. Is there a book or website that anyone else has found useful in covering the types of insurance that each patient is eligible for, what treatments are covered, which treatment options are the cheapest etc.?

Any help would be greatly appreciated!

-A

[Corey Narry, MSN, RN, NP]

Hi and welcome to AN and congrats on your impending graduation.

In my years as a bedside RN, I never really gave much thought about patient insurance and what they covered. I felt that for the most part, patients should get the nursing care they need regardless of who's paying for the services and as long as I'm their nurse, that's what I intend to accomplish in my shift. However, some understanding of insurance reimbursement does help in the long run. I've been an NP for a while now and knowing to what extent insurances cover what service is important.

For a basic understanding of these, a google search is your friend. Medicare is a federally funded program of health care insurance for people 65 and older. As part of the workforce, we all contribute to Medicare through deductions on our paycheck in order to maintain the viability of this program. Medicare covers the cost of hospitalization and everything that goes along with it as well as physician visits in the clinic.

Medicaid programs are run by the individual states. We also pay into it by our taxes. They are sometimes called under different names depending on the state (Public Aid, Medi-Cal, etc.). These insurances are offered to eligible individuals only, usually in situations where a person has limited financial ability to pay for their own healthcare. The personal asset limit and enrollement criteria are set by the individual states. Medicaid covers all the medical needs of the insured both in the hospital and in the community.

The rest of the other insurances are privately owned. Examples of these are Blue Cross, Blue Shield, Aetna, Kaiser Permanente, etc. In this age of the Affordable Care Act, individuals who are not covered by an employee sponsored health insurance and do not qualify for Medicare or Medicaid, must enroll through an insurance exchange consisting of many types of these privately-owned insurance companies. Their coverage is relatively similar to Medicare and Medicaid.