Medicare Patients—Benefits and Costs Assess the differences in benefits and costs, which are available to Medicare patients based upon the patent selecting either the “Traditional” Medicare program or Medicare Part C (Advantage Plan)

Question One

Traditional Medicare defines a standard benefit plan that covers medical healthcare services omitting the coverage of prescribed drugs. This type of Medicare comprises multiple advantages like having low costs. Once one has paid for the social security taxes for 40 calendar quarters, he receives free part A. Similarly, this Medicare package does not have an out-of-pocket maximum on what patients spend on health services. The Medicare package provides a standard package that covers medically necessary services relating to the patient’s healthcare. The disadvantages of this package comprise the fact that it does not cover the prescribed drugs. Besides, the package offers a short timeframe for appealing any denied claim in healthcare coverage. This situation renders the plan ineffective since the patients may have limited access to healthcare coverage. Private insurance corporations provide Medicare part C coverage plans (Medicare advantage) to incorporate Medicare part B and Medicare part A (Afendulis, Landrum, & Chernew, 2012). Eventually, these coverage plans provide additional benefits. Medicare advantages cover prescription drugs, unlike traditional Medicare coverage. Part C Medicare coverage plans also offer personalized plan structures where patients may access plan types for their situations (Lockett, 2021). The negative factors that define part C Medicare coverage include high costs for the additional coverage. Here, the coverage consolidates parts A, B, and Part D or other Medigap costs with additional fees at times. Also, Medicare advantage coverage has limited-service providers where patients are limited to few providers of the service. Besides, patients spend expensively to access out-of-network providers with Medicare advantage coverage services. Therefore, patients should be keen when choosing the coverage plans to empower their access to better healthcare.

Question Two

The two Medicare coverage plans may be utilized differently by different entities to offer proper healthcare coverage. The traditional Medicare coverage would effectively work for a physician. The official qualifies for the coverage plan since he attains 40 employment quarters paying to social security. Thus, he would have the opportunity to enjoy a free monthly premium. Besides, the physician may comfortably access healthcare at any hospital or doctor, which gives him more assurance of receiving proper healthcare coverage at any time anywhere irrespective of his condition. Also, the official enjoys reducing costs for the provision of healthcare coverage services to him. Although the coverage plan does not cater to the prescribed drugs, it offers an adequate benefits package that enables adequate services to the clients. Thus, any physician should be comfortable with subscribing to the traditional Medicare coverage strategy. On the other hand, a hospital should subscribe to part C Medicare coverage. This argument links to multiple factors like offering all the healthcare coverage services, including prescribed drugs. Furthermore, hospitals have adequate funds to pay for the part C Medicare cover providers (Berenson, Sunshine, Helms, & Lawton, 2015). Also, various hospitals may easily communicate with the specialists providing Medicare advantage coverage to the clients. Whenever the Medicare advantage does not meet any claim, the hospital may comfortably appeal for clarifications. Furthermore, any hospital would have an emergency case that needs quick attention from more skilled personnel.  Similarly, as healthcare providers, hospitals require coverage that meet the needs of patients in the current society. Medicare advantage coverage would effectively cater to the need since it incorporates modern techniques to provide adequate cover to its customers.

Question Three

The capitation model involves payments agreed upon through capitated contracts by health insurance companies and medical providers. The agreements encompass fixed, pre-arranged monthly charges received by a clinic, a physician, or hospital per capita included in health plans (Kagan, 2021). The monthly payment is evaluated before the year begins, like a year earlier, and remains constant in the agreed year irrespective of the number of times the patients need healthcare services. Capitation rates are created using average service utilization and local costs. Insurers and physician associations utilize this payment model to pay doctors per registered patients or hospitals for a specific period.

The significant reason for the use of capitation mode links to minimizing costs in healthcare.  Many plans determine risk pools as percentages of capitation payment. Physicians withhold the money throughout the fiscal year. Whenever the health plan performs well, the medical giver receives this money. Based on the terms used in both traditional Medicare coverage and Medicare advantage discussed above, both coverage use the capitation model. The argument links to how patients pay for the insurance coverage irrespective of the number of times they visit the healthcare facilities for any service. Also, the patients are required to pay certain amounts each month to enjoy the coverage terms provided by the insurers. Both Medicare coverage plans give room for appeal by the clients if any of their claims are not paid attention. Similarly, in the capitation model, healthcare providers receive payment whenever the healthcare plan goes on well. Therefore, the capitation model plays a crucial role in shaping payment plans used by multiple healthcare insurers.