Managed Care vs. Medicare: Key Differences in Care

When it comes to senior care payment options, you’ll likely come across the terms “managed care” and “Medicare.”

The good news: both are common and viable options, especially for short-term rehabilitation and skilled nursing services.

The challenge: They both have several nuances and differences in areas such as pre-approvals, length of stay and other key criteria that can impact care.

We’re here to save you hours of Googling, waiting on hold for answers, or your head spinning in confusion. Let’s break down the key details and differences between managed care and Medicare.

Medicare & Managed Care – The Key Differences

Traditional Medicare Managed Care
Administration Federal government Private insurance companies
Provider choice Wide choice of providers Limited to in-network providers
Scope of Coverage Standard, but may have limits related to long-term care Determined by specific plan or network of providers
Long-term care coverage Limited, usually for short periods Coverage may vary among plans
Cost structure Higher upfront costs (premiums and deductibles), but lower copays Lower upfront costs and higher copays
Pre-approvals Not required Required for services and hospital admissions
Referrals Not required Some plans may require referrals
Care coordination More flexibility in choosing providers Primary care physician (PCP) required for referrals

Considerations in Skilled Nursing and Long-Term Care

Let’s dive into how managed care and Medicare impact senior settings:

Choosing Quality Senior Care with Catholic Charities NH

Here at Catholic Charities NH, we offer a holistic approach to senior care that caters to diverse payment options, including many managed care plans as well as traditional Medicare, ensuring that residents receive the care they deserve, no matter their financial situation.

Learn more about our person-centered, compassionate senior care.