Major Differences Between Managed Care and Traditional Medicare
The healthcare industry has changed a lot recently, giving patients more choices in how they access and pay for medical services. Two common options that are readily available to patients include Traditional Medicare and Managed Care. Both of these are good for older adults who frequently need skilled nursing as well as short term rehabilitation.
In the USA, healthcare is a big part of the economy, and it makes up almost 18% of the country’s total GDP. Managed care and traditional medicare have several differences in things like getting approval before treatment, costs, and what services are covered. Next, we'll look at these differences in more detail between the two care plans.
Traditional Medicare - What Is It
The Federal Government has launched this program for senior citizens who are aged 65 years or older than that. Youngsters with some disabilities are also part of the group. Traditional medicare comprises of 4 different parts -
• Part A - Covers skilled nursing care, home care services, hospital stay and care, etc.
• Part B - Covers outpatient services like doctor visits, preventative care, medical equipment, etc.
• Part C - Covers other ways to get healthcare benefits, also knows as Medicare Advantage
• Part D - Covers different types of prescription drugs
You don’t require a network or any type of pre-approval for this care plan. To cover prescription drugs and other expenses, you can purchase other plans as well.
Managed Care - What Is It
Private insurance companies and healthcare providers join forces to provide Managed Care. They cooperate and coordinate to deliver healthcare services to patients. This includes two types -
• HMO or Health Maintenance Organization - It has a primary doctor to manage all care services in the network.
• PPO or Preferred Provider Organization - It’s quite flexible as patients can consult healthcare providers that aren’t in the network. However, it is expensive compared to HMO.
Even though the premiums, deductibles, and other upfront costs are low in Managed Care, there are lesser number of providers and pre-approval is required for several services. It is the better option to prevent sickness and diseases as there is a primary doctor to take care of everything.
Main Differences Between Managed Care & Traditional Medicare
The following are the major differences between both these care plans across various important parameters.
Cost Structure
Under traditional Medicare, you pay for each service you get from healthcare providers. This can lead to high-quality care, but sometimes providers offer extra treatments just to make more money.
In Managed Care, providers get a preset fee for each patient regardless of how many services they use. This encourages providers to offer treatments that are necessary and cost-effective.
Choice of Providers
With Traditional Medicare, you can choose any doctor or healthcare provider you like without needing a referral. But the cost of your plan can change based on who you choose.
In Managed Care, you have to follow rules and choose from a list of approved providers. If you need specialized care, you'll need a referral from your primary doctor.
Scope of Coverage
Traditional Medicare usually covers basic services with several limits on long-term care. These plans are often limited and last for a short time period.
Managed Care coverage can vary depending on your plan. It can cover short-term as well as long-term care as approved by your primary doctor.
Care Coordination
In Traditional Medicare, the patient has to coordinate between different providers and healthcare services himself, which can sometimes lead to confusion and overlapping.
Managed Care assigns a primary doctor to coordinate all your care and everything related to it. This includes treatment plans, referrals, and tests, making sure everything runs smoothly and coordinated.
Conclusion
Every single person starts becoming weaker and vulnerable to health issues as they age, and at some point, they need someone to take care of them in their daily life. Make sure to get the best medical care, tailored nursing help, and the necessary prescription drugs for a healthy, stress-free life.
Experienced professionals like Carleesha Porter Delgardo CEO of Working Nurses Home Care can help you out if you are finding it hard to find the right healthcare plan for yourself.
In the USA, healthcare is a big part of the economy, and it makes up almost 18% of the country’s total GDP. Managed care and traditional medicare have several differences in things like getting approval before treatment, costs, and what services are covered. Next, we'll look at these differences in more detail between the two care plans.
Traditional Medicare - What Is It
The Federal Government has launched this program for senior citizens who are aged 65 years or older than that. Youngsters with some disabilities are also part of the group. Traditional medicare comprises of 4 different parts -
• Part A - Covers skilled nursing care, home care services, hospital stay and care, etc.
• Part B - Covers outpatient services like doctor visits, preventative care, medical equipment, etc.
• Part C - Covers other ways to get healthcare benefits, also knows as Medicare Advantage
• Part D - Covers different types of prescription drugs
You don’t require a network or any type of pre-approval for this care plan. To cover prescription drugs and other expenses, you can purchase other plans as well.
Managed Care - What Is It
Private insurance companies and healthcare providers join forces to provide Managed Care. They cooperate and coordinate to deliver healthcare services to patients. This includes two types -
• HMO or Health Maintenance Organization - It has a primary doctor to manage all care services in the network.
• PPO or Preferred Provider Organization - It’s quite flexible as patients can consult healthcare providers that aren’t in the network. However, it is expensive compared to HMO.
Even though the premiums, deductibles, and other upfront costs are low in Managed Care, there are lesser number of providers and pre-approval is required for several services. It is the better option to prevent sickness and diseases as there is a primary doctor to take care of everything.
Main Differences Between Managed Care & Traditional Medicare
The following are the major differences between both these care plans across various important parameters.
Cost Structure
Under traditional Medicare, you pay for each service you get from healthcare providers. This can lead to high-quality care, but sometimes providers offer extra treatments just to make more money.
In Managed Care, providers get a preset fee for each patient regardless of how many services they use. This encourages providers to offer treatments that are necessary and cost-effective.
Choice of Providers
With Traditional Medicare, you can choose any doctor or healthcare provider you like without needing a referral. But the cost of your plan can change based on who you choose.
In Managed Care, you have to follow rules and choose from a list of approved providers. If you need specialized care, you'll need a referral from your primary doctor.
Scope of Coverage
Traditional Medicare usually covers basic services with several limits on long-term care. These plans are often limited and last for a short time period.
Managed Care coverage can vary depending on your plan. It can cover short-term as well as long-term care as approved by your primary doctor.
Care Coordination
In Traditional Medicare, the patient has to coordinate between different providers and healthcare services himself, which can sometimes lead to confusion and overlapping.
Managed Care assigns a primary doctor to coordinate all your care and everything related to it. This includes treatment plans, referrals, and tests, making sure everything runs smoothly and coordinated.
Conclusion
Every single person starts becoming weaker and vulnerable to health issues as they age, and at some point, they need someone to take care of them in their daily life. Make sure to get the best medical care, tailored nursing help, and the necessary prescription drugs for a healthy, stress-free life.
Experienced professionals like Carleesha Porter Delgardo CEO of Working Nurses Home Care can help you out if you are finding it hard to find the right healthcare plan for yourself.
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