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Senior Health>Medicare Insurance
Managed Care Plans (HMO)>> |
Medicare Advantage Managed Care Plans
Managed Care Plans (HMO) are offered by private insurance companies to Medicare
eligible beneficiaries. Seniors may go to doctors and hospitals that are part of
the plan?s network, which will provide most of the enrollee’s care. Managed care
plans emphasize prevention and wellness, encouraging enrollees to take advantage
of services meant to maintain and improve health.
What do they cover?
Benefits are usually quite comprehensive, but will vary by plan. Many will begin
to offer an outpatient Prescription Drug benefit as part of the Medicare Part D
reforms. Inpatient and outpatient services, equipment and home health services
are covered to varying degrees, as are preventative services, diagnostic testing
and other services.
How much do they cost?
Medicare Advantage Managed Care plans sometimes have a monthly charge in
addition to the Part B payment to Medicare. However, there are a number of new
plans with $0 per month additional charge. The beneficiary pays for services per
the plan?s individual schedule of co-payments or co-insurance.
What are specific advantages?
HMOs have a very important advantage over other types of plans- coordination of
care. This means that every physician has strong communication links with other
physicians, meaning that as a patient your health care team is all working
together. This can have strong benefits for patients with more complicated
medical needs.
What are specific disadvantages?
For some people, the need to define a Primary Care Physician is limiting. There
is also the requirement that the patient have a referral to see specialists.
Finally, there will be additional cost to getting medical care from provicers
who are outside the network (except in emergency circumstances).
For whom are they appropriate?
In general, Medicare Advantage Managed Care Plans are appropriate for patients
for whom:
a) Medicare Advantage is the best way to cover health care expenses (vs. Medigap
plans);
b) a low monthly price is very important;
c) medical visits can be easily done within the plan?s network of providers and
facilities.
How do I select the right plan?
In any case,
selecting the right plan is a complex process that should take into
consideration a number of factors specific to the beneficiary. Put
eBenefitsByDesign.com to work finding
your plan. To compare your Medicare health plan choices, please call
our toll free number or
Complete
our Medicare Information Request Form.
If you have questions call our Toll Free Number
@ 888.995.2821.
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