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Medicare Managed Care: What You Need To Know

MEDICARE MANAGED CARE:  WHAT YOU NEED TO KNOW

Each year, Medicare plans change what they cost and what they will cover.  Many seniors will face decisions regarding Medicare's prescription drug benefit.  Medicare's annual Coordinated Election Period, in which beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time, runs from November 15 through December 31 each  year.   Enrollment changes take effect January 1.

These new managed care plans have been given wide latitude regarding the benefits that can be offered, as long as benefits currently available under Medicare Parts A & B are included.  Financial incentives in the form of lower premiums, expanded benefits such as Pharmaceutical coverage, and lower deductibles and co-pays will be powerful inducements for many seniors struggling to make ends meet.  In order for you to make a sound business decision regarding participation in any of these managed care plans, however, some hard questions must be asked.

MEDICARE PATIENTS NEED TO KNOW:

  1. What are my new co-pays?  Some plans have a co-pay for chiropractic that may be higher than the charge for the service itself.  These excessive co-pays effectively eliminate the chiropractic benefit.
  2. What limits are there on access to care?  Managed care plans attempt to lower costs by limiting access and fees paid to providers.  Will you be able to continue to seek care from your current chiropractic physician when you feel you need to?  Will you need a referral?  Can you go to an out-of-network provider, and, if so, at what cost?
  3. Are there added costs?  While the marketers of these new plans will emphasize areas where you can save, there may b hidden costs.  The plan could include higher deductibles and/or co-pays for "specialty" services, out -of-network providers, non covered diagnostic tests, second opinions, etc.  And, you may find that if you go outside the managed care network, you may be responsible for all costs.
  4. What are the plan's special rules?  Is there an appeal process?  All plans will have rules and procedures that must be followed.  You need to understand these rules and learn how potential coverage and payment disputes will be handled.
  5. Will you have control over your own care?  You need to know if needed care is limited, if referrals are required, or if there are any other restrictions that will affect you.

It is very important that you educate yourself about these new Medicare managed care options.  Once you select a plan, you are committed to the plan for one year.  You are only able to change plans (or return to Medicare Part A & B) during Medicare's yearly enrollment periods.