The Difference Between Care and Coverage

There is a big and distinct difference between care and coverage. We have to be careful to not use these words interchangeably. Anyone can receive the care they need without having the coverage to pay for it, and anyone can have the coverage they need without reasonable access to the care they need covered. This is a problem in our country that will not be fixed by a new health care bill.

Finding The Problem

In many cases, doctors are performing a costly service by accepting Medicare and Medicaid patients, leading them to stop accepting. Medicaid may not reimburse doctors in full for patients who are eligible for copay-free care. When a doctor accepts that patient, he is losing out on time with another patient that could be giving him $20 or more for that visit. Doctors are losing the incentive to provide care for Medicare and Medicaid patients, so now patients with the right coverage can’t always find the care.

Alternatively, clients who have found the care they need and have access to doctors who accept Medicare and Medicaid can’t always afford the coverage. The coverage they have means that their medical bills will be significantly lower, but not low enough.

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Fixing The Problem

As healthcare professionals, what can we do?

For starters, we need to be incredibly detailed and careful in discussing both coverage needs and finances with our clients. We need to be clearer about what doctors our clients can use with their plans. Take doctors into consideration when helping clients choose plans. We also need to avoid confusion and unknown fees by outlining every single charge that a client may find with their plan selection.

Health care is confusing, and the market is heavily saturated. It’s up to us to get our seniors and Medicare eligibles the care AND coverage they need to get by.

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