A Medicare managed care plan is one type of Medicare Advantage plan. The term “managed care plan” generally refers to HMO (health maintenance organization), PPO (preferred provider organization) or POS (point of service) plans. These Medicare Advantage plans offer managed care that is coordinated between health care providers within a network.
The opposite of a managed care plan would be a Medicare PFFS (private fee for service) plan. These plans do not utilize a primary care physician or require referrals to see specialists, and they generally do not include a network of health care providers.
As a member of a managed care plan, a beneficiary will typically see a primary care physician for any illnesses, injuries or conditions. When possible, the primary care physician will treat the patient.
If the primary care physician is unable to administer the necessary treatment, they will refer the patient to a specialist, typically within the plan’s network. A managed care plan fosters a more team-oriented approach to the beneficiary’s health.
There are some advantages to using a managed care plan:
As previously mentioned, managed care plans can include a few different types of Medicare Advantage plans.
For more information about managed care plans or other types of Medicare Advantage plans, including plan benefits, eligibility, enrollment and availability, contact a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
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