8 Points to Consider When Choosing a Medicare Managed Care Plan
Medicare doesn't come in only one flavor. There's traditional Medicare Part A and Part B, supplemented by a medigap private insurance policy. But there are also Medicare Part C managed care plans, called Medicare Advantage, which blend the other types of coverage into one. If your parent considers enrolling in a Medicare Advantage plan as an alternative to traditional Medicare plus a medigap policy, make sure to check the following things first:
Are all the doctors my parent usually sees in the managed care plan's network?
The basic rule of Medicare managed care is that a plan will pay its full share only for care received from a doctor in the plan's network, a roster of doctors who are under contract with the plan. Many plans pay nothing at all if your parent receives care from a doctor outside the network; others pay only a small portion of the bill. If all of your parent's doctors are listed on a plan's network, that plan becomes a good candidate. If some of your parent's regular doctors are not on the network and she wants to stay with them, then look for another plan, or opt for traditional Medicare plus medigap, which covers virtually all doctors. On request, a Medicare Advantage plan will provide you with its current network list, which is usually also on its website.
Does the plan's network include a wide selection of nearby specialists?
Your parent should consider not only whether her current doctors are on the network list but also whether the network includes a wide selection of specialists near where she lives. This is especially important in rural and suburban areas where the number of specialists may be limited. Although your parent may not need any of these doctors right now, the reality of aging is that specialists are likely to come into the picture sooner or later.
Is the hospital where my parent would be admitted in the plan's network?
Not every hospital is in every Medicare Advantage plan network. If your parent's doctors refer their patients only to a particular hospital, or if your parent's home is near only one good hospital, make sure that hospital is in a plan's network before signing up with that plan.
What are the plan's total costs -- premiums plus deductibles and copayments?
A Medicare Advantage plan may have a very low monthly premium, or even no premium at all. But that doesn't tell you what the actual cost of the plan would be for your parent. Before enrolling in a plan, make sure she knows whether she must pay the monthly Medicare Part B premium; what the plan's own premium is; and what the plan's copayments and deductibles are for inpatient hospital or nursing-facility stays, doctor visits, outpatient hospital visits (including the emergency room), X-rays, laboratory work, and physical and occupational therapy.