Healthcare is one of the most important and basic human wants and should always be available to an individual anytime one requires medical attention. However, the healthcare sector is also amongst the expensive ones to manage within a nation. It is the government’s responsibility to ensure that all its citizens have access to quality and affordable healthcare by investing the required number of resources towards healthcare coverage for their citizens. The government also works together with various institutions from the private sector to offer affordable healthcare insurance plans for their people. Some of the significant healthcare insurance plans that have had positive impacts in the healthcare sector are the Medicare and the Medicare advantage plans. This paper strives to highlight and compare some of the advantages of Medicare and Medicare advantage healthcare coverage plans by comparing the premium costs, doctors and hospitals choice, and coverage.
The Medicare healthcare plan is a federal health insurance program implemented by the government towards achieving universal healthcare coverage goals in the health sector. The scheme was mainly started for individuals who do not have adequate financing for appropriate healthcare even though they suffer from various life-threatening illnesses (Medicare.gov). It is majorly aimed at considering elderly individuals, people living with different forms of disability and people with permanent kidney failure. The Medicare healthcare plan has brought about positive results in the health sector since more individuals are able to seek medical attention without having to worry or strain about financial constraints.
The Medicare healthcare coverage program is offered in three different packages where the patient must choose one suitable for their needs. The first package is the Medicare Part A, which is the hospital insurance coverage. Hospital insurance coverage includes all the inpatient stay expenses in a quality healthcare facility, hospice care charges and home healthcare. The second package is the Medicare Part B, which is the medical insurance cover (Agarwal et al., pp. 937–944). It majorly covers various doctor’s care services and medical supplies charges to the patient. The last package is Medicare Part D, which is the prescription drug coverage healthcare insurance. It majorly covers for all the expenses according to the healthcare giver’s prescriptions.
The government also introduced the Medicare Advantage healthcare coverage plan as a federal healthcare program to enable the citizens to acquire appropriate healthcare. The plan enables one to easily get the Medicare Part A and Part B packages under one plan by bringing all the resources required into a single pool to enhance effectiveness during allocation (Agarwal et al., pp. 937–944). The plan is majorly utilized by only approved private healthcare facilities in the health sector. It is also considered an all-inclusive package, and most employed individuals in the United States of America find it more efficient than other healthcare insurance coverage plans in the healthcare sector.
The plans available in the Medicare Advantage healthcare coverage scheme include the Health Maintenance Organization Plan, which enables a patient to acquire healthcare services from hospitals or healthcare organizations affiliated with the healthcare insurance company. It also has a Preferred Provider Organization Plan which enables a patient to have the liberty of acquiring healthcare services from any healthcare institution of their choice (Meyers and Johnston, pp. 14–34). The patient can also get help from other doctors who the healthcare insurance company does not contract to offer various health interventions to their clients. Private Fee for service plan is also available in the Medicare Advantage plan. An individual can easily determine how much they can pay after receiving healthcare services and how much the healthcare providers will be paid.
Both the healthcare coverage plans have benefits to their target clients since a significant number of the citizens of the United States of America have subscribed to either of the packages. Looking into the advantages of the healthcare coverage plans, it is appropriate to compare the quality of hospitals and doctors who have partnered with the insurance company to treat their clients (Meyers and Johnston, pp. 14–34). The costs incurred by the patients are also a major aspect in comparing the benefits of each of the plans. The content of the coverage plan may also have a great influence on an individual. Patient travel and movement aspects may also influence an individual to decide on which coverage plan to settle on.
Comparing Hospitals and Doctors Choice
Most healthcare coverage insurance companies have partnered with various healthcare practitioners and institutions to ensure that their clients receive quality healthcare services. However, they have different packages from which their customers can choose that will satisfy their well-being in the healthcare sector. The Medicare plan and the Medicare advantage plan have different arrangements for their patients when providing qualified caregivers and institutions to attend to their client’s healthcare needs (Hughes and Vernon). The Medicare plan is advantageous for the citizens of the United States of America in that it allows their clients to seek medical attention from any hospital or doctor in the United States that accepts Medicare plan without being referred (Hughes and Vernon). The Medicare Advantage plan requires an individual to visit only the doctors who have been contracted by the insurance company and are in the organization’s network. They may also require one to have referrals to visit some of their specialists.
Comparing the Costs Incurred
Medicare Plan and Medicare Advantage plan have varying costs for healthcare coverage to their target clients in the market. A large number of the American citizens who fall under the middle-class social class prefer the Medicare plan to the Medicare Advantage plan due to their friendly financial costs. Some of the aspects that make the Medicare Plan more advantageous financially are that it allows for coinsurance as opposed to the Medicare advantage plan (Deng and Benítez-Silva, p. 25). The Medicare plan does not have any yearly limit on out-of-pocket payment, whilst the Medicare Advantage plan has imposed a yearly limit on out-of-pocket payment. Individuals under Medicare Plan can also enjoy access to Medigap advantages to help them settle some of their out-of-pocket arrears. In contrast, the Medicare Advantage plan does not allow their clients to buy Medigap services in the United States of America.
Medicare Advantage plan provides a better package as compared to the Medicare original plan. This is because it provides for coverage for extra health conditions that cannot be covered by the Medicare original plan (Agarwal et al., pp. 937–944). The Medicare advantage plan also provides a client packages that include drug coverage, whereas Medicare plan requires an individual to acquire a separate drug plan to have access to the prescribed drugs.
Comparing Travel and Patient Movement
Both Medicare and Medicare advantage plan do not have healthcare coverage packages that cover for patient care outside the United States of America. The plans majorly aim at ensuring the development and efficiency of local American healthcare facilities. However, an individual has the liberty to acquire another Medigap cover that caters for beyond the border’s healthcare services (Agarwal et al., pp. 937–944). The organizations also have invested resources towards the development of various medicine and drugs for effective healthcare in America.
Most individuals in the United States of America prefer the Medicare original plan due to the user-friendly aspect of the package. A bigger percentage of the American citizens make up the middle-class individuals who cannot afford paying for the Medicare Advantage plan. Individuals with high financial income in the united states of America prefer the Medicare Advantage plan due to the extra healthcare benefits included in the plans.
Agarwal, Rajender, et al. “Comparing Medicare Advantage and Traditional Medicare: A Systematic Review.” Health Affairs, vol. 40, no. 6, 1 June 2021, pp. 937–944.
Deng, Yuanyuan, and Hugo Benítez-Silva. “An Empirical Model of Medicare Costs: The Role of Health Insurance, Employment, and Delays in Medicare Enrollment.” Econometrics, vol. 9, no. 2, 2021, p. 25.
Hughes, M. Courtney, and Erin Vernon. “Closing the Gap in Hospice Utilization for the Minority Medicare Population.” Gerontology and Geriatric Medicine, vol. 5, 2019.
“What’s Medicare? | Medicare.” Medicare.gov, 2019, Web.
Meyers, David J, and Kenton J. Johnston. “The Growing Importance of Medicare Advantage in Health Policy and Health Services Research.” JAMA Health Forum, vol. 2, no. 3, 2021, p. e210235.