Comparing Medicare And Medicaid Managed Care Plans

The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Medicaid has help many qualified Americans who were historically unable to access health care. At the same time, it has raised questions and controversies as how efficient is the plan overall. Various research studies were conducted and contradicting results were presented. According to Paradise and Garfield (2013), some said that having no coverage at all is better that having a Medicaid coverage. On the other hand, some expressed that Medicaid paved a way to improved health due to increased access to services that provides prevention of diseases, health maintenance, and effective treatment (Paradise & Garfield, 2013). As for me I am in favor of the later, health care access for all. It comes down to equitable distribution of resources

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Benefit provisions vary from one state program to another, but federal guidelines require all states to provide a minimum benefit package, including hospital inpatient and outpatient care, physician care, and many other services. In the area of long-term care, all states are required to pay for nursing home care, and they must also pay for home healthcare for those who are “nursing home eligible” which are those who would need nursing home care if they did not receive home care. And although federal guidelines do not require it, an increasing number of states also pay benefits for home and community-based services. These services may include personal care, home health aide services, rehabilitation, therapies, intermission care, homemaker services, and other services. In addition, a few states pay for long-term care services received in an assisted living residence. Unlike Medicare, with its highly restrictive conditions for payment of nursing home or home care benefits, Medicaid generally meets the need for long-term care (for those who eligible). Medicaid pays benefits for personal and supervisory care even if skilled care is not needed, and the program covers ongoing care needed to cope with a chronic impairment, not just care required for a short time to facilitate recovery from an acute illness or injury. However, there are some important limitations to Medicaid long-term care benefits: (1)

Dual eligible beneficiaries are among the poorest and sickest of those covered by either Medicare or Medicaid and, subsequently, they account for a disproportionate share of spending in both programs. Yet unfortunately their care is disjointed, with little to no coordination. State and federal agencies, managed care organizations and advocates all agree that the misalignment between Medicare and Medicaid must be addressed. The varying rules, overlapping benefits and conflicting financial incentives between the two programs greatly affect the nearly 10 million beneficiaries nationwide who are dually eligible for both programs.

Medicaid and Medicare are two programs that are very different but share the same instance of being federally run programs. Both Medicaid and Medicare were created in 1965 in response to the fact that older and lower income people could not buy private insurance. Medicaid is dispersed individually by each state in which is primary role is to cover low income people who do not have the financial means to purchase healthcare on their own. On the other hand Medicare is paid into by everyone that works a legal job where taxes are deducted. Medicare was created to address the issues of elderly; typically people 65 years or older; having extremely high healthcare bills but limited personal funding. These people will typically pay part of the cost

When President Barack Obama ran for office in 2008 he vowed to revolutionize the healthcare environment as it stood. With overwhelming election resuts Obama took the helm as the leader of our nation’s Medicaid program and immedialty begain lobbying for legislation to expand. Not since 1965 had our nation seen such a demeand from a president to change the landscape of healthcare for consumers and providers alike. One of the crucial elements of The Patient Protection and Afordable Care Act (Obamacare) was the need for states to expand eligibility to Medicaid in a bid aimed at improving the health of the welfare of the country Medicaid is a component of what the federal government enacted in the year 1965 that seeks to finance the delivery of better and affordable health care services to those designated “needy families” and to children. The program required states to expand the eligibility criteria to 138 percent of the federal government poverty levels to allow for the increased coverage of the children and an increase in the number of low-income earners. However, the Affordable care Act made the decision to expand the eligibility criteria the discretion of the States resulting in different state level governments opting for different approaches as some chose to expand while others decided not to expand. The subject is essential since it provides a clear insight into the effects policies pose to the healthcare sector and how people are affected. This study also allows one

Medicare Advantage Plans, an alternative to traditional Medicare, are operated by companies that contract with the federal government to provide all of the same services that people would normally receive from Medicare's Part A and Part B. Participants still pay their Medicare premiums, however, they may have be subject to different rules regarding care, which may include higher co-pays or additional services not covered by Medicare.

Generally, you must have been paid into the system to be qualified for it. Unfortunately, Medicare will not pay long-term care. But it is categorized into four parts (Medicare Part A, B, C, and D) for coverage choices. Part A (Hospital Insurance) funds hospital care, skilled nursing care (up to 100 days of care), nursing home care, hospice, and home health services. Part B (Medical Insurance) funds medically necessary services, preventive services, clinical research, ambulance services, durable medical equipment (DME), mental health, receiving a second opinion before surgery, and having limited outpatient prescription drugs.

Medicare and Medicaid are very different, Medicare is a insurance federal program while Medicaid is an assistant program for low income people of any age. Medicare then serve people over 65 years primarily, under Medicare patients pay the costs through deductibles for hospitals and other cost. Medicare consist in two part; Part A which is the hospital insurance and Part B which is the Medicare insurance, they also have Part A Premium and Part B Premium. The Medicare Part A Premium you pay certain amount of money a month, but if you are 65 and meet certain criteria that they have ,you can get the Premium-free Part A. Medicare Part B after you meet your deductible, you normally pay 20% of the Medicare approve amount for doctors services, including

On the other hand PPO plan has a managed care option for beneficiaries who decided to have a greater provider flexibility, with my PPO coverage portion kicks in. Also

After reading your post, I reminenced about my experiences with managed care. I have used HMOs and PPOs and I like the latter because of freedom. Freedom to choice the provider of my choice and not having to get a referral before I see a specialist. This freedom is something I'm willing to pay for eventhough the HMOs tend to be cheaper. Restricted care is not great healthcare in my opinion. There have been compromises with EPOs and POSs. Giving consumers more of a choice has expanded the blue oceans for these insurance

Due to the upcoming presidential election, the two major political parties, and their candidates, have been focusing on the primary problems that the nation will face. Chief among those problems is the future of Medicare, the national health-insurance plan. Medicare was enacted in 1965, under the administration of Lyndon B. Johnson, in order to provide health insurance for retired citizens and the disabled (Ryan). The Medicare program covers most people aged 65 or older, as well as handicapped people who enroll in the program, and consists of two health plans: a hospital insurance plan (part A) and a medical insurance plan (part B) (Marmor 22). Before Medicare, many Americans didn't have health

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.