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Medicare - Managed Care Plans

Prepaid health care plans known as managed care plans, such as competitive medical plans (CMPs) and health maintenance organizations (HMOs), are options for Medicare beneficiaries. Managed care plans function on a basis different from regular fee-for-service covered under Medicare. Under managed care plans, the Medicare beneficiary selects a specific HMO, CMP, or other approved plans within a service area for comprehensive health care services. It is central to the managed care concept that this selected plan coordinate all of the health care services for that person. Managed care plans function on a financial basis that is different from the traditional fee-for-service reimbursements to health care providers. Managed care plans receive a per-person payment from Medicare that is predetermined, based on a formula that is established by law and the demographic characteristics of the Medicare beneficiaries enrolled in their plan.

In addition to the regular services covered under Medicare, the managed care plans often cover services such as preventive care, prescription drugs, eyeglasses, dental care, or hearing aids. Electing to participate in a managed care plan may also serve as an alternative to purchasing "medigap insurance" which is often wanted if the beneficiary has traditional fee-for-service coverage. Although there are certain restrictions, limitations and differences from the fee-for-service plans, the managed care plan's fixed monthly premiums and cost-sharing structure helps to provide more predictability for out-of-pocket costs for the beneficiaries who do not have medigap insurance.

See these topics for additional information:

·   Medicare - Overview

·   Medicare - Coverage

·   Medicare - Financing, Liabilities, and Payments

·   Medicare - Claims Processing

·   Medicare - Administration

·   Medicare - Data Summary

·   Medicare - Other Considerations

·   Relationship of Medicaid and Medicare

·   Medicare (Part D) Prescription Drug Coverage

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