Beneficiaries may encounter many new phrases when navigating Medicaid, and “managed care” may seem confusing at first. However, the underlying concepts are quite simple – and it may only take a few minutes to become confident about how managed care works. Simply put, managed care refers to the manner in which your loved one receives healthcare services. The government refers to this as a “health care delivery system” that involves budgeting, quality control, and other organizational steps. The type of managed care depends on your home state, and it may be difficult to create a targeted strategy without help from an experienced elder law attorney.

What Exactly is Managed Care, Anyway?

Managed care is the method by which states provide eligible people with Medicaid benefits. The process involves contracting a private insurance company to provide health care services, and the company receives a certain amount of money each month in return.

Although this might seem pretty simple, the Commonwealth Fund notes that managed care can be “extraordinarily complicated” in many areas of the country. Managed care is now the most common way in which beneficiaries receive healthcare benefits. In 1990, only 10% of eligible recipients enrolled in managed care – but now that number has risen to well over 50%.

Managed Care vs. Fee-for-Service

Fee-for-Service (FFS) is the alternative to managed care. Under FFS, the state compensates the healthcare provider for each service you receive. Many beneficiaries are not aware that there are two different systems when it comes to Medicaid. The differences between these systems are somewhat controversial, with many arguing that one is superior to the other. For example, some point out that under FFS, beneficiaries can choose their own specialists. On the other hand, they could be charged for visiting the ER if it was not a true emergency. While the pros and cons of FFS and managed care represent a completely different topic, beneficiaries should know that they at least know that they may have a choice.

Understand the Costs Involved

It may help to sit down and discuss the various costs involved with managed care. Typically, managed care plans are cheaper compared to FFS – especially if you choose a Health Maintenance Organization (HMO). These organizations help limit costs while ensuring high-quality care – a difficult balancing act that does not always turn out well.

In the end, each beneficiary has unique priorities and needs when it comes to healthcare – and it will be difficult to navigate managed care effectively without a solid understanding of your own needs. Remember, part of this planning process involves treatment that you may need at some point in the future.

It may be helpful to discuss these potential future needs alongside your doctors. Pay close attention to genetic conditions that your family members may have. Consider your current health limitations and how they might degrade or improve in the future. After this discussion, you can take what you’ve learned to your elder law attorney. Your lawyer can then help you determine the most appropriate path forward.

Understand the Focus on Preventative Care

If you choose managed care, you should understand that this system focuses considerably on preventative care. This is part of the cost-limiting strategy, but it can also help you avoid preventable health concerns. It might seem like this is simply to lower costs for the insurance companies, but all doctors understand that preventing illnesses makes much more sense compared to treating them after they appear.

As a result, you may be encouraged to get annual check-ups. You might also be encouraged to take vaccines. Screenings may also become more frequent as you age, and this is something you should probably make time for.

Consider Your Health Network

If you choose managed care, you might want to consider your health network and the quality of healthcare in your specific state. It is no secret that some states have better healthcare systems than others, and it may make sense to relocate in order to take advantage of this. Each state has its own specific Medicaid network and program, and you may need to research these differences before your move.

You can also target specific states for other benefits, including homestead exemptions and lower tax rates. An elder law attorney may be able to help you choose the most optimal state based on your unique retirement needs. Finally, it is worth noting that not every state offers managed care plans. If you live in a state that does not offer managed care plans, you might need to relocate before you even consider this option.

Dual Eligibility and the Danger of “Fragmented Care”

If you are eligible for both Medicaid and Medicare, it might be more challenging for you to navigate this process compared to others. There is a real danger of receiving “fragmented care” due to the lack of integration between these two programs. However, various states and insurance providers are attempting to address these issues for dual-eligible seniors.

You might be able to find an “integrated care plan” that serves only dual-eligible people in your community. Often, these plans cater to people in nursing homes. Because these organizations focus on dual-eligible individuals, they can integrate and coordinate their treatment with greater efficiency. Speak with your elder care lawyer to learn more about integrated care plans.

Contact The Elderly Care Law Firm Today

Medicaid planning can be challenging if you are working alone. You may feel intense pressure to provide your loved one with effective healthcare services, and it may feel like this task has become a full-time job. Fortunately, you can delegate many aspects of Medicaid planning to an experienced elder law attorney. During your first consultation with one of these legal professionals, you can discuss how your specific state handles managed care. You might also discuss your senior’s unique challenges and priorities. From there, you can ensure your loved one receives the best health care possible. To get started, consider a consultation with The Elderly Care Law Firm today.