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Medicare Advantage and Qualified Health Plans
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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.
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Medicare Advantage, Qualified Health Plans, and Medicaid Managed Care Organizations
These three plans operate under the legislation as set by the federal government. Even then, these have major differences that sets them apart. First is the type of prescription drugs they can provide. Medical Advantage (MA) is legally bound to offer drugs in six precise classes which including cancer medications. Quality Health Plans (QHPs) have no protected classes while on the other hand; Medicaid Managed Care Organizations (MCOs) must legally abide to Food and Drug Administration (FDA) approved drugs (Lipschutz and Callow).
Each of the plans mentioned above has its advantages and disadvantages. Besides having securely set costs that can never exceed $6,700 no matter the cause, MAs provide more benefits such as fitness center membership, prescription drug coverage routine dental care, hearing aids, and routine vision care than the traditional fee-for-service (FFS) Medicare at cost-effective prices (Rivlin and Daniel). On the downside, MAs limits an individual’s freedom when it comes to the choice of healthcare providers where they would seek freedom.
QHPs cover a wide range of categories of medications including but not limited to emerg...
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