Comparision of Managed Care Products

Critical Assignment 6

Getting to know Medicaid, Medicare and Tricare can take care of a large portion of patients depending on your setting. We are going to look at the three plans, determine what patient demographic each covers, what costs are involved and who administers the programs. Also we will cover the advantages and disadvantages that each plan has.

Insurance | Plan | Who administers | Who is eligible | What are the costs | What is covered | Advantages of the plan | Disadvantages of the plan |

Medicare | | | | | | | |

| Part A | Federally funded/government | Individuals over the age of 65 and select individuals who meet specific disability requirements | Free for those who paid Medicare taxes while working/ to buy up to $426 per month | Hospital inpatient care, 100 skilled nursing care, hospice care and home health | Can only accept A if you like, majority of individuals receive for free | Only covers hospital care and nothing related to outpatient care, only covers certain geographic regions |

| Part B | Federally funded/government | Individuals who are eligible for part A | Ranging from $104.90-335.70 depending on the yearly income as reported to Social Security by the IRS plus a yearly deductible of $147 | Physician services, medically necessary services, outpatient care, preventive service, mental health, durable medical equipment | Supplement to part A to cover other necessary costs such as physician care and outpatient, covers preventive care | Cost based off of income plus a deductible, does not cover vaccines, hearing aids or more than one routine checkup per year, confusing enrollment process |

| Part C | Commercial managed care insurance companies on behalf of the government | Individuals who are eligible for parts A and B | Varies depending on the plan you select plus a copayment per visit of $10-20 | Cover same as part B but ran as a managed care plan through Medicare Advantage with a commercial insurance plan. |...