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Medicare Advantage Plan
For a United States citizen to be eligible for Medicare, a publicly provided health insurance program, they must be at least 65 years of age or have end stage renal disease. Since it is publicly provided, the federal government regulates, funds, and administers Medicare. It is also the largest health insurer in the US with close to 50 million enrollees (Medicare Made Clear).
Medicare is broken up in to four parts:
- Traditionally, Medicare Part A has no monthly premium but are responsible for a $1200 annual deductible. It only covers inpatient services and hospital care. Citizens over 65 do not have to sign up; they are automatically enrolled for Part A (Santerre & Neun, 2009).
- A voluntary extension of Part A, adding on outpatient services, emergency room services, and physician care. Enrollees pay a monthly premium of about $100 with only a $140 annual deductible (Santerre & Neun, 2009).
Part C or
Medicare Advantage Plan
- Can be used in place of Parts A and B. Unlike a traditional Medicare program, a Medicare Advantage Plan is not publicly administered; that is to say, the government does not provide these plans. They are provided in the private market and are appealing to elderly citizens who are turned off to the idea of public insurance (Medicare Made Clear).
Usually offered through one of two Coordinated Care Plans (Santerre & Neun, 2009):
1. Health Maintenance Organization- insured cannot leave a designated network of care facilities, or else care will not be covered.
2. Preferred Provider Organization- there is a financial incentive to stay in network. Leaving the network will cover less of the cost.
The plan is customizable, so carriers can craft their own coverage package to include dental, vision, prescription, physician care, etc. The premiums and deductibles vary on these plans based on what coverage the insured gets, but the government usually pays more per enrollee than with public plans.
- An extension of either Parts A and B or Part C. For an increase variable premium, Medicare Part D will cover prescription drug coverage (if it's not already under a Medicare Advantage Plan). Has 40 million enrollees (Santerre & Neun, 2009).
Since Medicare is the most popular health insurer in the nation and consistently growing, it furnishes great opportunities for Health Informatics application, especially considering the technology-gap between the older generation and others. Telemedicine can help combat this technology gap. Elderly living with chronic disease are usually responsible for a heavy medication regiment, and if they have no caretaker, then it is easy to take an inappropriate dosage. Elderly people insured with a Medicare Advantage Plan would benefit from HIT remote patient monitoring interventions.
Medicare Part C
Santerre, R.E., Neun, S. P. (2009)
Health Economics: Theory, Insights and Industry Studies, 5th Edition
Boston, MA: Cengage Learning.
10 Key Medicare Facts. (n.d.). Retrieved October 17, 2014, from
Figure from kkf.org
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