Health Care Coverage Comparison

Group Health Insurance Comparison

Medicare is a federal health insurance plan for people over 65 years old and some disabled people. It is the primary insurance carrier for old people and the disabled. On the other hand, blue cross is the secondary insurer that covers most of what the primary insurer fails to pay (BlueCross BlueShield Association, 2009). In its design, Medicare does not cover all health care costs which mean clients covered by Medicare are responsible for a high percentage of their health care costs. Medicare patients have to dig deep into their pockets in order to repay for some of healthcare cost.  It has been established that doctors often charge more for the services they deliver than what Medicare will pay and patients are left with a deficit to cover for medical services.  Comparing the medical cost between Medicare and Blue Cross, it is evident that in Blue cross, one pays $ 122 a month while in Medicare you pay $ 1,156.80 per year.

The two also differs in terms of service they offer.

The amount of coverage covered by Medicare depends on whether one has a coverage under Medicare part A, Medicare part B or both. Some services are not covered by Medicare and these are services that consumers have to pay direct from their pocket.  These services include:
Long term care at a nursing home or at home.
Most oral prescriptive drugs
Routine physicals.
Care for patients with Medicare as the secondary payer.
Comparison of Medicare and blue cross benefit plans on provider limitation
Medicare

Medicare is primary for retired employees covered through a retiree benefit plan by an employer. It is secondary for disabled people with a large group health plan based on their own current employment status, or those disabled individuals whose LGHP is based on a family member’s current employment status.

Medicare coverage consists of Part A and B as described below:

a. Part A covers hospitals and skilled nursing facility care. It therefore pays a portion of the hospital bills and the patient is has to find means of paying other services that are outside this bracket.

b. Part B covers medical bills and other medical expenses. Pays a portion of the doctors’ bills.

In design Medicare Plan A is mandatory while Plan B is optional. This means that those individuals who cannot afford to pay for service offered under part B will forego them since it is mandatory.

However, research  have shown that individuals covered under Medicare are not prone to out of pocket expense as they may incur some out of the pocket expenses even with Part A and B coverage. These expenses may be in different areas including:

Part A hospital deductible
Co payments for hospital stay over 60 days
Care in a skilled nursing facility after 20 days.
Part B deductible
20% co insurance for doctor bills and other medical expenses.

Therefore, Medicare can be considered as the primary medical insurer while Blue Cross is the secondary medical insurer and it pays 20% of what Medicare does not pay.

However, while Blue Cross pays more than Medicare, there is a risk. Having Blue Cross as the primary insurer at age 65 and without Medicare, Blue cross has an option of dropping you.

Medicare pays for care needed after a one time event e.g. an elderly man falling and breaking a leg but it will not pay for the need for care that gradually increases with age. This means that individuals may be required to find another cover like Blue Cross to cater for the increase expenses that comes with age.  However, Blue Cross is not self sufficient by itself as the enrollees of blue cross must use Medicare providers (Medavie Blue Cross, 2010). It is also important to understand that providers of blue cross must be certified with Medicare. Also, understand that Blue care does not pay claims if the provider is not part of Medicare.

Unlike Medicare medical treatments, drugs, devices, diagnostic procedures are not covered by Blue Cross until final review and approval by the coverage committee. It has the right to revise update or put additions to the policies at any time without prior notice (Medavie Blue Cross, 2010).

Unlike Medicare that has limited plans Blue cross comes with different health plans. Blue cross plans include:

Core medical
Anthem Blue Cross Plus
Anthem blue cross PPO
High option

Comparative prescription plan

There are notable differences in prescription between the two. Their prescription plans can be separately reviewed as follows:

Blue cross: -

Blue cross monitors the prescription of drugs through the administration of a prescription monitoring system. It uses a fully electronic online, real time system that is designed to communicate with existing pharmacy software (Medavie Blue Cross, 2010).

The prescription monitoring system offers services that include patient profiles, patient profile monitoring, analysis of prescribed patterns, and patient treatment agreement monitoring. The prescription monitoring system offers useful information to prescribers and pharmacists (Medavie Blue Cross, 2010). This helps to reduce abuse of monitored drugs. The prescription monitoring system has key features that ensure its effectiveness. These key features include real time data availability, instant messaging at the time of dispensing, refined data analysis, maintenance of provider registry and the management of triplicate prescription pads.

Medicare: -

The prescription plan for Medicare is covered in Part D. It is offered through Medicare- approved private plans. The prescription plan is available to anyone eligible for part A and/or B. It covers both brand name and generic prescription drugs (Salzman, 2005). This is done at the participating pharmacies and it helps in lowering prescription drug costs and protects against higher costs in the future (Medco Nedicare, 2009). The annual cost for the coverage depends on the type of plan that one chooses, amount of coverage that one receives, and the region where one lives.

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