Reference no: EM133037818
Payer Comparisons
Instructions:
- Two parts to the assignment.
- Listed on the grid below are several examples of payers including Medicare, Commercial Insurance, and Managed Care. Complete the grid to help you organize your information in preparation to respond to the questions in Part B.
- All responses are to be entered on this worksheet.
Part A: Instructions
Fill all components of the grid utilizing course readings, lesson content and by researching the three plans.
|
Elements
|
Medicare
|
Commercial Insurance
|
Managed Care
|
|
Selection of Providers
|
|
|
|
|
Risk Adverse
|
|
|
|
|
Cost Sharing
|
|
|
|
|
Deductibles
|
|
|
|
|
Individual, Family or both types of enrolment
|
|
|
|
|
Medical Necessity or Prior Approval
|
|
|
|
|
Premiums
|
|
|
|
|
Medicare Advantage Plans
|
|
|
|
Part B: Instructions:
- Provide answers to the 9 questions below using information obtained in Part A of the assignment. Note-several questions have multiple parts.
- Indicate your source or reference for each of the responses for the 9 questions.
- Indicate if more than one source was utilized for each question with multi-part responses.
1) Explain the difference in philosophy on risk between Medicare and Managed Care. Indicate if they are risk adverse-why or why not.
2) Which of the payers have deductibles in their plans?
3) How is medical necessity checking handled with Medicare?
4) How the prior approval process is managed for Commercial and Managed Care plans?
5) Which of the payers require Premiums from their members for inpatient services?
6) What is the relationships of Medicare Advantage Plans with Commercial and Managed Care Plans?
7) Which plans allow for individual enrollment? Family enrollment? Or both?
8) How does Managed Care manage the selection of providers? Medicare? Commercial payers?
9) Identify based on your review which type of plan would BEST meet your needs as a patient and why.