Comparison and Contrast of Medicare and PacifiCare (HMO) Plans, Essay Example

Medicare is a program of social insurance that the government of United States gives to the people. It provides health insurance coverage to those people who are 65 years and above or who meet some specific criteria. This program also funds for residential training programs for the physicians in United States. Medicare usually operates in a system called single payer health care system. PacifiCare is part of United Health Care family of the insurance companies. They also include the oxford health plans and the golden rule (Mark, 2008). PacifiCare specializes in health insurance, insurance for seniors, life insurance as well as dental and vision care services. PacifiCare is usually an organization for the consumer health. It specializes in managed care plans. It is one of largest company of health as well as consumer services. Its main operations are providing the primary operations like the health insurance products for the employer groups as well as the Medicare beneficiaries. Unlike the Medicare, it gives variety of services not only health insurance. It also differentiates itself from the Medicare in that it does not have age limit. It is not also controlled by the government as in the case of Medicare.

PacifiCare health systems also operates an organization that is a non-profit called PacifiCare Foundation, this provides educational and charitable services to the society towards enhancing the welfare of the families, individuals and the public at large. In some areas like the California, the PacifiCare health system operates through commercial providers who are contracted. They work over 230 hospitals, 30000 primary care units and over 4000 pharmacy locations. PacifiCare provides managed health plans that give top quality health services that are affordable. PacifiCare provide or creates a network of hospitals, doctors and other providers. The care providers give services to members at a discount while the providers get more business and referrals as payback (Med health insurance, 2010).

Medicare on the other hand is provided by the centers for Medicare and Medicaid Services (CMS) which is a branch or component of Department of Health and Human Services (HHS). Medicare is financed partially by the payroll taxes that are imposed by the Federal Insurance Contributions Act. For one to be eligible for the Medicare benefits, you should be 65 years or older and be U.S. citizen; any one who is under 65 but be disabled and receiving social Security benefits or the rail road retirement board benefits of disabilities for around 24 months; one must be getting continuing dialysis for end stage renal disease or in need of a kidney transplant.

They are several benefits of the Medicare program; they include the hospital insurance which covers anyone who stays in the hospital for at least an overnight which includes the semiprivate room, tests, food and the fees for the doctors. It may also cover a brief stay in skilled nursing facility under certain criteria like if one stays in the hospital for at least three days, three midnights without counting the discharge date. The nursing home stay must also be something that has been diagnosed in the hospital stay. One can also be covered by the Medicare if he requires skilled nursing supervision for some ailments even if one is not receiving the rehabilitation. The medical insurance is also another benefit helps one in paying some services as well as products that are not covered in the health sector; this is usually an outpatient basis. This is usually optional in case the spouse or the beneficiary is actively working. This coverage includes the nursing and physician services, influenza and pneumonia vaccinations, renal dialysis, limited transportation, laboratory and diagnostic tests among others. It also includes other medical treatments that are administered in the doctor’s office.

There are various challenges facing the Medicare like the increasing cost of the Medicare expenditure each and every year. It is said that the cost has increased very significantly for years. The other problem is that the ratio of the workers or people paying Medicare taxes to the retirees getting the benefits is shrinking each and every time and the cost of health services per person is increasing day by day hence the financing of the program becoming a serious challenge in both long and short term (Hoovers Inc., 2005).

PacifiCare health system provides health care services to all people and not like the Medicare which gives those services to the older generations or those who are under extreme conditions.  It provides variety of services and products in support of the customers from all aspects of life and people with all kinds of needs. It gives variety of health care services as compared to Medicare system which includes dental and vision services, pharmacy benefits and other benefits. PacifiCare also provides a lot of freedom in choosing a physician without addition cost. In addition, members may see a doctor who is out of network although at a higher cost. PacifiCare also provides a plan that allows one to see a doctor or even a specialist without a referral in a plan called indemnity plan. The PacifiCare requires one to contribute each and every time and a lot of money as compared to the Medicare.

References

Mark, M. (2008, January). The Value of Extra Benefits Offered by Medicare Advantage Plans In 2006. Retrieved February 9, 2010, from http://www.kff.org/medicare/upload/7744.pdf

Med health insurance. (2010, February). PacifiCare Health Systems. Retrieved February 9, 2010, from http://www.medhealthinsurance.com/pacificare.htm

Hoovers Inc. (2005). Hoover’s Handbook of American Business 2005. New York: Hoovers Inc.