Pros and Cons of Managed Care
Managed healthcare in today's world seems to be leaning in favor of the insurance carriers, not the provider or patient. Caregivers that attempt to operate a cash practice are taking a huge risk. In today's healthcare world, it is almost imperative that doctors are participating in medical insurance plans, for their businesses to survive.
The advantages of managed care plans include:
1. Co-payments are pre-determined, a person always know how much they will be paying out-of-pocket for services. The employee’s out-of-pocket medical expenses are generally limited to office visit co-payments and a minimal dollar amount, if any, for hospitalization.
2. Older adults who are on limited incomes, but are not eligible for Medicaid, are able to obtain insurance coverage.
3. Decisions regarding health care are generally made by the HMO, and the patient has access to a wide variety of skilled professionals.
4. Much of the paperwork is eliminated.
5. Quality of care issues have been brought to the forefront. Physicians and other health care providers are now more aware of the type of care they provide and the outcomes of that care.
6. Some limited prescription drug benefits are offered by the plans. However, they usually use a formulary that consists primarily of generic drugs.
7. Cost of managed care is usually less than indemnity plans for seniors and for other persons.
8. HMOs generally offer certain “well-care” services as a covered benefit that may not normally be a part of other types of health plans, such as immunizations, annual physicals and well-child visits. Some services may be offered which indemnity plans do not offer, such as eye exams, eyeglasses, dental care or other services.
9. Older adults sign over their Medicare benefits to the health maintenance organization. The health maintenance organization collects a sum of money each month to provide care to the individual from Medicare. The individual can only see physicians that are approved by the
The advantages of managed care plans include:
1. Co-payments are pre-determined, a person always know how much they will be paying out-of-pocket for services. The employee’s out-of-pocket medical expenses are generally limited to office visit co-payments and a minimal dollar amount, if any, for hospitalization.
2. Older adults who are on limited incomes, but are not eligible for Medicaid, are able to obtain insurance coverage.
3. Decisions regarding health care are generally made by the HMO, and the patient has access to a wide variety of skilled professionals.
4. Much of the paperwork is eliminated.
5. Quality of care issues have been brought to the forefront. Physicians and other health care providers are now more aware of the type of care they provide and the outcomes of that care.
6. Some limited prescription drug benefits are offered by the plans. However, they usually use a formulary that consists primarily of generic drugs.
7. Cost of managed care is usually less than indemnity plans for seniors and for other persons.
8. HMOs generally offer certain “well-care” services as a covered benefit that may not normally be a part of other types of health plans, such as immunizations, annual physicals and well-child visits. Some services may be offered which indemnity plans do not offer, such as eye exams, eyeglasses, dental care or other services.
9. Older adults sign over their Medicare benefits to the health maintenance organization. The health maintenance organization collects a sum of money each month to provide care to the individual from Medicare. The individual can only see physicians that are approved by the