18d • General discussion
Medicare, Medicare Advantage, Medicaid and MCO's
Here’s the breakdown.
When you’re working in care management, consulting, or building services in value-based care, you have to understand how coverage and payment actually work. Because these programs shape access, authorizations, networks, documentation expectations, and what patients can realistically get.
In these slides, I walk through:
- What Medicare is and who it serves
- The parts of Medicare (A, B, C, D) and what each one covers
- What Medicare Advantage (Part C) is, why it exists, and how it operates in real life
- What risk adjustment means and why documentation matters
- How Medicaid differs from Medicare
- What Managed Care Organizations (MCOs) are and where they fit in Medicaid and Medicare Advantage
- A clear, step-by-step comparison of Original Medicare vs Medicare Advantage (pros and cons)
If you’re supporting older adults, working in primary care, or building care management services, this is foundational knowledge. It helps you advocate better, plan smarter, and avoid surprises when care hits a coverage wall.
Save this for reference, and drop questions in the comments.
Natasha
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Medicare, Medicare Advantage, Medicaid and MCO's
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