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Medicare Advantage, Qualified Health Plans, and Medicaid Managed Care Organizations are often interchangeably confused with one...

Medicare Advantage, Qualified Health Plans, and Medicaid Managed Care Organizations are often interchangeably confused with one another. Review the article below, specially the chart of key difference. For your Module 4 Discussion, discuss the key differences, pros, and cons of each.
Lipschutz, D. & Callow, A. (2015). Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations. Retrieved from https://www.kff.org/medicare/report/comparison-of-consumer-protections-in-three-health-insurance-markets/

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Medicare Advantage Qualified Health plans Medicaid Managed care
Key Differences It is offered by the private companies which cover the Medicare benefits. It is also called as MA plans or Part C. An insurance plan that provides health benefits within the limits and also meets the requirements based on ACA. Also known as Minimum essential coverage. It provides health benefits and additional services through the Contracted medicare organizations.
Pros
  • It costs $0 for a month in most of the plan.
  • It covers the drug cost.
  • Can switch off to different MA plan.
  • It includes dental and hearing coverage.
  • coverage includes geriatric, maternity, mental health, and specialty drugs.
  • No pre-existing condition is needed for the application process.
  • Children can cover under the plan up to the age of 26.
  • It lowers the cost of healthcare.
  • It covers the care within the area.
  • Prescriptions are affordable.
Cons
  • Individuals require fees of copays and coinsurance.
  • Plans are similar so difficult to choose.
  • The process switching to MA plan is difficult.
  • Change of medical coverage every year.
  • Includes the benefits of unwanted things.
  • It has an annual enrollment period.
  • It has very high deductibles.
  • Some of the premiums are very expensive.
  • It limits the care of individuals who are uncovered.
  • Referrals are necessary.
  • Loss of privacy.
  • Need to wait for a long time.
consumer Protection
  • Right to have covered drugs.
  • Protect from an unreasonable rate of insurance.
  • Right to easy understand of health benefits.
  • Covered the pre-existing condition.
  • Right to receive the free services.
  • Can stay on a parent's health plan until 26.
  • Protect against employer retaliation.
  • Right to appeal for decision.
  • Right to have a referral for the specialist.

Nightingale answered 2 years ago
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