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Medicare managed care plans - Change in the scenario of senior health care

All over the world a certain trend of giving traditional insurance a miss is catching up. This is not exactly new and has existed ever since the managed care variety of health plans arrived. Honestly, the world comes across many more Preferred Provider Organizations (PPO’s) and Health Maintenance Organizations (HMO’s) than the common fee-for-service plans. The concept of managed care coverage has now entered the world of Medicare too. Anyone who becomes eligible for Medicare coverage has to choose a way to receive the benefits. Making managed care plans the medium is a good idea since the benefits come through a locally placed PPO or HMO. The benefits of course remain the same irrespective of fee- for-service coverage or managed care coverage.

How you get your Medicare benefits through traditional coverage and managed care coverage depend on the way each type functions. When you are under the fee-for-service system, you need to pay a charge every time you avail physician services or other specialized services. From the total medical bill, Medicare offers to pay a part and you need to settle the rest from your own reserve. Fee-for-service options allow you to make use of supplemental plans in case you find the original Medicare plan benefits to be inadequate for your requirements. For managed care plans, Medicare and you share the burden of health costs on a pre-paid basis. The highlight of Medicare managed care lies in the fact that it combines the characteristics of both an insurance company and a provider system that comprises health centers, hospitals and medical professionals.

Like an individual needs to meet up certain requirements in order to be termed eligible for Medicare, the same goes for Medicare managed care plans as well. There are four main requirements that need to be fulfilled in order for you to enroll for a Medicare managed care plan. The very first among them states that you must be enrolled under Medicare Part B. Only if you pay your Medicare Part B premiums on a regular basis can you hope to have access to Medicare managed care. Secondly, you cannot opt for care from a hospice that’s certified by Medicare. In other words, hospice care (from a certified hospice) cannot be a part of your Medicare managed care plan. Thirdly, Medicare managed care does not consider End Stage Renal Disease. This means you cannot enroll under a Medicare Managed Care plan if you have ESRD. The last one is the simplest condition yet the toughest one to ensure. It states that you need to ensure that the plan you’re planning to opt for must serve the area you live in.

Once you have been able to fulfill all the necessary conditions, getting yourself enrolled under a Medicare managed care plan is not all that difficult. The best way to gain first hand knowledge about these plans is to call Medicare at 1-800-638-6833. No matter which managed care plan you choose, all plans that team up with Medicare need to have an open enrollment period of a minimum of 30 days. If you happen to be a Medicare beneficiary you have the added advantage of accessing a Medicare managed care plan since none can refuse you coverage citing health conditions.


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