What Is a Medicare Managed Care Plan?

Medicare Managed Care Plan functions as a supplement to regular Medicare since some of the services offered are not a part of regular Medicare. This plan is also known as ‘Prepaid Health Care’. The managed care plan is an alternative to Medigap in that this system uses a fixed monthly premium and copay structure making it easier for patients to calculate out-of-pocket expenses.

How Medicare Managed Care Differs from Medigap

Under the Medigap plan medical bills must be submitted both to Medicare and the gap insurance provider. With Medicare Managed Care Plan all medical bills are submitted directly to Medicare and must include basic coverage offered by regular Medicare. Medicare Managed Care premiums and copay are determined by Medicare as opposed to gap insurance providers.

Medicare Managed Care Coverage Offered In Addition to Original Medicare

Payment of one premium provides such options as preventive care screenings, prescription drugs, eye glasses, dental care and hearing aids.

Medicare Managed Care Requirements And Restrictions

One basic requirement is that only network physicians, hospitals and specialists may be used If services are sought outside of the network unless in an emergency situation neither Medicare nor Medicare Managed Care Plan will pay any of the costs. If a specialist is needed there must be a referral submitted by the primary care physician.

Advantages and Disadvantages Associated With Medicare Managed Care Plan

A definite economical advantage afforded by Medicare Managed Care Plan is receiving additional options at a lower cost in some cases with Medicare paying a large share of the premium.

One requirement of Medicare Managed Care Plan is patients must live within the plan’s service area which in rural areas may result in a smaller physician hospital and specialist network. Out-of-pocket expense can be greater if the needed specialist is not a network member.

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