Medicare plans In addition, HMO advantage plan often pay additional coverage for hospital stays that exceeds the limits set by traditional Medicare.
Some of the weaknesses of Medicare managed care is that the choice of healthcare provider and medical facilities are limited, prior approval is necessary from a primary care physician for specialists services, surgical procedures, medical equipment, and other health care services which is not required under traditional Medicare, and members are covered only for healthcare services received through HMO except in emergency and urgent care situations (Beik, 2014, p. 165).
In contrast, one of the strength of Medicaid is its Medicaid spend down program. Even if the individual’s income exceeds Medicaid …show more content…
Due to the increased rate of Medicare and Medicaid spending, the Obama Administration are finding ways on how to control it. One of this is the reduction of Medicare and Medicaid funding. The reduction of Medicare and Medicaid funding leads to poor health care access and quality of care because of the insufficient physician participation in both programs. Reducing Medicare and Medicaid health care spending is not easy, House Budget Committee Chair Paul Ryan’s proposals rests on the notion that patients are in the best position to control costs and that it's therefore desirable to shift to them the risk associated with cost growth. The administration's plan is rooted in the view that the federal government should retain its role as guarantor of a defined benefit and make health care providers more accountable for costs and quality. Debate over these options should recognize the inherent trade-offs among the certainty of cost control, the likelihood of achieving cost savings while preserving as much high-value care as possible, and the risk that the most vulnerable Americans will pay the highest price for fiscal discipline (Rosenthal,
Some of the weaknesses of Medicare managed care is that the choice of healthcare provider and medical facilities are limited, prior approval is necessary from a primary care physician for specialists services, surgical procedures, medical equipment, and other health care services which is not required under traditional Medicare, and members are covered only for healthcare services received through HMO except in emergency and urgent care situations (Beik, 2014, p. 165).
In contrast, one of the strength of Medicaid is its Medicaid spend down program. Even if the individual’s income exceeds Medicaid …show more content…
Due to the increased rate of Medicare and Medicaid spending, the Obama Administration are finding ways on how to control it. One of this is the reduction of Medicare and Medicaid funding. The reduction of Medicare and Medicaid funding leads to poor health care access and quality of care because of the insufficient physician participation in both programs. Reducing Medicare and Medicaid health care spending is not easy, House Budget Committee Chair Paul Ryan’s proposals rests on the notion that patients are in the best position to control costs and that it's therefore desirable to shift to them the risk associated with cost growth. The administration's plan is rooted in the view that the federal government should retain its role as guarantor of a defined benefit and make health care providers more accountable for costs and quality. Debate over these options should recognize the inherent trade-offs among the certainty of cost control, the likelihood of achieving cost savings while preserving as much high-value care as possible, and the risk that the most vulnerable Americans will pay the highest price for fiscal discipline (Rosenthal,