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Senior Health Insurance - Considering Medicare Managed Care plans instead of Medigap plans

Plans that cover the ‘gaps’ left by original Medicare insurance. That is exactly how people in the US know Medigap insurance or Medicare Supplemental insurance. Medicare Managed Care, on the other hand, explores the idea of plans contributing to part of the cost of medical care (the other part should be paid by the member of course) through Medicare. Both Medicare managed care and Medigap seek to offer services not available on original Medicare. The difference really lies in the way each of these options offer coverage to members. Medigap insurance operates much like a partner to Medicare in that they both have to pay certain portions of the eligible medical expenses. Medicare managed care on the other hand takes care of coverage single- handedly. It not only offers basic benefits provided by original Medicare but also covers advantages not covered by the latter.

Medicare managed care plans are the newest addition to senior health insurance options. More often than not plans in this category are not expensive and works well for people from almost all sections of society. Plan providers achieve lower prices by getting into an agreement with members that the latter will consult only a select group of specialists, medical centers and hospitals. This, in other words, is called a network. Whether you can venture out of the given network or not is a relative issue that differs from plan to plan. While some plans are stringent when it comes to allowing members the privilege of availing services beyond the network, others are more flexible and gives adequate freedom to policyholders. In general Medicare managed care plans in the form of PPO’s and HMO’s demand higher premiums since they offer members the choice to consult professionals from within the network and beyond it.

It is great if you’re thinking of opting for Medicare managed care plans but first make sure you know the basics. Do you get Medicare managed care at affordable rates in your nearby area? This is an important question to which you can find a proper answer only if you know the types of plans that exist -

  • Health Maintenance Organization - Medicare managed care plans of this type allow you to enjoy maximum benefits when you avail in- network services. If you wish to opt for out- network services, you can’t expect your plan to pay up for any of the services. Also Medicare does not come forward to offer coverage when providers outside the network happen to serve you. On such a plan you’ll need to select a Primary Care Physician (PCP) who’ll help you with all majormedical decisions and give you referrals as well.
  • Preferred Provider Organization - On a PPO plan, your costs will remain controlled as long as you avail services within the provided network. Premiums and even co- pays will rise the moment you choose to step outside the network. Unlike HMO’s, PPO’s do not always require you to get referrals for specialist consultation.
  • Provider Sponsored Organization - Unlike HMO’s and PPO’s, PSO’s do not have middlemen to reach out to patients. They do that directly. The mode of paying up, though, remains the same.

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