Over the past few years, the healthcare industry has changed a lot, with patients now having multiple options to access and finance medical services. Two options that you must surely have heard about are ‘Traditional Medicare’ and ‘Managed Care’. For senior citizens, both these options are viable for getting access to skilled nursing as well as short-term rehabilitation.
In the USA, healthcare is a large part of the overall economy, and comprises 18% of the country’s GDP. One thing you should know is that there are several differences between managed care and traditional healthcare related to pre-approvals, costs, care coverage, etc. In the following post, we’ll check out the key differences between both these care plans.
What is Traditional Medicare?
It’s a health insurance program by the Federal Government for seniors over the age of 65, and for some youngsters with disabilities. Traditional Medicare consists of three different parts –
- Part A – This covers hospital stays and care, home care services, skilled nursing care, and more.
- Part B – This covers medical supplies and outpatient services that include preventive care, doctor visits, and other medical equipment.
- Part C – Also known as Medicare Advantage, this provides other ways to get healthcare benefits
- Part D – This covers prescription drugs
Usually, traditional medicare has a higher upfront cost that includes deductibles and premiums, but lower services copays. You don’t need any pre-approvals or networks for it, and can buy complimentary plans to cover prescription drugs and other expenses.
What is Managed Care?
Private insurance firms partner with a healthcare providers network to operate Managed Care plans and conveniently deliver and co-ordinate their services. Managed Care is of two main types –
- Health Maintenance Organization (HMO) – In this, you must have a primary doctor to manage all care services within your network.
- Preferred Provider Organization (PPO) – In this, patients have higher flexibility as they can see providers that are not in the network, but it costs more.
In Managed Care, upfront costs like deductibles and premiums are low, but the choice of providers is lower and you may need pre-approval for some services. However, as it has a primary doctor, it is really helpful to prevent diseases and sickness.
Key Differences Between Traditional Medicare & Managed Care
Let’s check out the main differences among both these care plans across several key parameters.
Cost Structure
Traditional medicare works on a fee-for-service, where care providers bill every service offered. The quality of care is high, but some providers add treatments and procedures just to increase their revenue.
Managed Care follows a capitation system in which care providers get a pre-decided fee for each patient. No matter how many services a patient gets, the cost remains constant. This pushes providers to promote treatments and medicines that are cost-effective and necessary.
Choice of Providers
Medicare is quite flexible as patients can consult any doctor or healthcare provider who they trust. The patient has the freedom of choice and they don’t need any referrals for this. However, the total cost of the plan will vary based on the providers chosen by the patient.
It is not that simple to seek services from your choice of providers under Managed Care. There are several stipulations you must follow and choose from a pre-approved network of healthcare providers. Also, if a patient wants specialized services, then he will require a referral from the primary doctor.
Scope of Coverage
Traditional medicare usually offers a standard scope of coverage and there are some limits when it comes to long-term care. Most of these healthcare plans are limited and usually for a short duration.
The scope of coverage under managed care varies depending on the patient’s specific plan or the network of healthcare providers. The coverage can be both short as well as long-term according to the patient’s plan and primary doctor’s approval.
Care Coordination
In traditional medicare, coordination depends on the patient as they navigate among different providers and receive proper care services. However, if there is improper communication, it leads to overlapping and disjointed services.
Managed care has seamless coordination as there is a primary doctor assigned to the patient who coordinates everything related to his care services. Right from treatment plans, to referrals, to diagnostic tests, the primary doctor coordinates every step in a proper manner.
Conclusion
There comes a point in life when we cannot take care of ourselves anymore and healthcare becomes a necessity. If you are unable to find a Managed Care plan, then experienced professionals like Carleesha Porter Delgardo CEO of Working Nurses Home Care can help you out. Ensure that you get the best medical care, tailored nursing help, and the best prescription drugs for a healthy, stress-free life.