Question

I need a help with this question please briefly

Please, explain the Medicare benefit structure and how private health plans may provide and manage those benefits?

Please, discuss the basic issues involved with Medicare Advantage and managed Medicaid plans?

Answer 1

Benefit structure:

• Part A covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits, and hospice care.
• Part B covers physician visits, outpatient services, preventive services, and some home health visits.
• Part C refers to the Medicare Advantage program, through which beneficiaries can enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically also Part D benefits.
• Part D covers outpatient prescription drugs through private plans that contract with Medicare, including stand-alone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs).

Private health plans v. Medicare :

The main difference is that Medicare pays for patients to be treated in the public health system and private health insurance pays for patients to be treated in the private health system. Differences between the two systems include how much patients pay for treatment (the gap between doctors’ and hospitals’ fees and the benefit from Medicare or insurance), how long they wait for treatment, what doctor treats them, and even what they pay in tax each year. Medicare needs better cost controls, but it's already cheaper and better than private insurance would be for Americans who are 65-plus. The real conundrum is how to get the same better deal for the rest of us.

Issues in Medicare Advantage and Medicaid Managed Care:

On paper, Medicaid is the best health plan anywhere. It covers almost every imaginable service, with zero payment due from the patient. In practice, the reality of Medicaid is quite different. Patients have insufficient access to health care providers and lack of coordination and continuity of care, mainly because of low payment rates; despite this, states and the federal government face rapid growth in total program costs.

Medicare Advantage plans may sound enticing. Many offer $0 premiums, but the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick and only want you as a customer when you’re healthy. Also known as Part C, these plans, which private insurers provide as an alternative to traditional Medicare, must provide the coverage required by Medicare at the same overall cost level. However, what they pay can differ depending upon your overall health.