Medicare Vs. Managed Care

Medicare

Original Medicare is an 80/20 plan, which means that the patient pays 20 percent of services rendered and Medicare pays 80 percent. All services must be at an approved Medicare facility or doctor's office.

Managed Care

Those on Medicare have a choice of enrolling in one of the approved HMOs, also known as Medicare Advantage. Under this plan, the patient pays flat co-pays for health services. The recipient continues to pay premiums to Medicare and any additional premiums for the Managed Care.

Significance

Since Medicare does not cover all expenses, Managed Care is a way to help the recipient know in advance what his payment for service costs will be. Once a person is enrolled, the Managed Care Plan will send a new insurance card in place of the Medicare card.

Considerations

Before enrolling in any of the Managed Care Plans available under Medicare, it is important to ensure that all current doctors are on the plan and will accept the HMO. Additionally, some of the Managed Care Plans include a monthly premium, which requires payment in addition to the Medicare Part B paid directly to Medicare each month.

Warning

Enrollment for Medicare Managed Plan is once per year, which is normally the last six weeks of the year. The enrollment remains locked until the next open enrollment period. The original Medicare plan is also known as the fee-for-service plan, since the recipient pays a percentage of care for each health service received. Managed Care, known as Medicare Advantage, allows the recipient to enroll in an HMO plan.