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Sample Paper on Similarities and Differences of Medicare and Medicaid Managed Care Plans

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Sample Paper on Similarities and Differences of Medicare and Medicaid Managed Care Plans
Strengths, weaknesses and incentives between Medicare and Medicaid

The diverging arrangements of both Medicare and Medicaid initiatives have led to differing incentives relating to double eligibility in recipients with no harmonized care. The major focus of both healthcare schemes is to trim down medical fees and none of the schemes has an incentive that takes into consideration the quality of medical care services presented. Medicare plan is managed by the national government and persons who are qualified for the plan are those who are 65 years and above, regardless of their salaries (Ridge, 2007). However, young persons who are disabled and are eligible for Social Security’s disability are also qualified for this program. Medicaid is a program managed by the government and offers insurance cover for each and every income-based worker of all ages. The major strength of both programs is that that they present individuals with an opportunity for double eligibility.

It is important to provide extensive acute on top of lasting health care services for dually qualified beneficiaries of both health care plans. The main limitation of Medicare is that it does not cover for services such as severe dental care and transportation services. The main service that is not insured by Medicare program is long-term medical care. Additionally, it mainly covers the aged and does not consider people below the age of 65 years. Medicaid also has a limitation in that it is more expensive in comparison with the Medicare program. Additionally, patients who are single must be financially insolvent so as to meet the requirements for Medicaid. Nonetheless it is apparent that each and every service that is not covered by Medicare is compensated by Medicaid health plan (Holahan, & McMorrow, 2012).

Commitment to access for both plans

Medicaid and Medicare programs have been for a long time the primary means through which a huge part of the population acquires access to medical care in America. It is apparent that Medicaid program is more dedicated toward supporting medical access than Medicare program. In 1960, approximately 10 million American’s citizens were registered for Medicaid program. This figure has progressively improved and presently, more than forty one million Americans are insured by the healthcare plan. The minimal dedication of Medicare is as a result of the absence of major improvement on eligibility prerequisites since 1970 (Grabowski, 2007). An example of Medicaid growth plan that has resulted in improved accessibility to medical care is the State children’s medical cover scheme. Medicaid plan may be seen as the best health initiative anywhere since it covers nearly every service that one can imagine but in reality, the dependability of Medicaid is rather different. Patients lack adequate access to medical care givers and there is lack of synchronization and continuity of health care. This is mainly as a result of reduced payment rates. Due to the ever growing costs of medical care, Medicare and Medicaid programs are struggling to create balance between access extension and regulation of charges. The main similarity among both programs is that they are financed by the government and also they work in collaboration to provide medical costs insurance to the underprivileged and aged population (Grabowski, 2007).

Risks to the consumer associated with either plan.

The cost expansion risk is part of the consumer risks linked with both health care programs. Insufficient medical services, is a consumer risk linked with Medicaid. With the growing number of patients who are covered, there are insufficient primary care physicians. General practitioners in various states are disheartened by Medicaid program. As a result persons insured by Medicaid scheme regularly are reported to have poorer health form when compared with the uncovered and those insured by private plans. An aspect linked with Medicare plan is barring physicians from receiving medical imbursement that exceeds the amount supposed to be compensated by Medicare recipients. Fraud and misuse, is an additional consumer risk that is linked with the two health care plans. With a large number of people being registered for these initiatives, fraud is a recurrent problem. The subject of misuse and fraud is common as a result of the fact that there is inadequate supervision to dealers, providers and other individuals who are involved in the health care programs (Holahan, & McMorrow, 2012).

Recommendations for improvement of each medical plan

There are several recommendations that may be of assistance in improving health care programs. The Medicaid plan is recommended to give better support to standardized eligibility. This would assist in solving the problem of unmarried patients’ prerequisite to be low-income earners in order to be covered. Another suggestion is for the plan to boost the amount of funds paid to doctors participating in the plan. This would enhance accessibility and the standard of medical services offered to patients covered by Medicaid plan. Owing to the fact that Medicaid program is more costly than Medicare, there should be attempts to trim down the costs. Consequently, this would reduce the consumer risk of augmented expenses.

On the other hand, the recommendation for the Medicare program is dependent on coverage, access and suitability conditions. Presently, only citizens aged 65 and beyond are qualified for Medicare program. Incorporating the rest of the citizens would endorse accessibility to medical treatment. Another proposal is lessening Medicare expenditure, which will assist in bringing down the fees of medical services for covered patients. It is also advisable for Medicare to increase the variety of services presented to beneficiaries. This should include long term medical services and additional ones such as transport services. This is due to the fact that the recipients are the aged populace and disabled children who may have inadequate access to transport amenities.

References

Grabowski, D. C. (2007). Medicare and Medicaid: Conflicting Incentives for Long‐Term Care. Milbank Quarterly, 85(4), 579-610.

Holahan, J., & McMorrow, S. (2012). Medicare and Medicaid spending trends and the deficit debate. New England Journal of Medicine, 367(5), 393-395.

Ridge, S. B. (2007). Medicare and Medicaid. In Fundamentals of Geriatric Medicine (pp. 73-79). Springer New York.

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