What is the Difference Between Medicare and Medicare Managed Care?
There are different ways to receive your Medicare benefits, including Original Medicare (Part A and Part B), Original Medicare with Medigap, and Medicare Managed Care. Medicare Managed Care plans are legally required to include all the services provided under Original Medicare but they come with a variety of additional benefits. There is also no need to buy a Medigap (or Medicare supplement) plan when you have Managed Care – in fact you cannot have both. With so many different plans and options, we want to help break it down for you.
Questions about Medicare Managed Care plans
Is Medicare Managed Care the Same as Medicare Advantage?
Yes, Medicare Managed Care plans are a different way to say Medicare Advantage plans or Medicare Part C plans.
How do Medicare managed care plans work?
Medicare Managed Care plans are offered by private insurers that have a contract with Medicare. These plans are overseen by Medicare and the contract requires the plan to follow a set of rules and regulations. If you choose a Medicare Managed Care plan, it is instead of Original Medicare coverage but includes all of the same benefits. Most plans require their members to visit health care providers and facilities within their network to receive the best coverage.
While Part C plans may come with a monthly premium, they do typically include additional services such as hearing, dental, and vision care. They also have an annual out-of-pocket maximum that is not offered to those who choose Original Medicare.
What types of Medicare Managed Care plans can I choose from?
There are different types of Medicare Managed Care plans to meet different needs. If you are transitioning from employer-based healthcare to Medicare, you may recognize these plan types.
According to Medicare.gov, these are the most common types of Part C plans:
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNPs)
Some of the less common Medicare Advantage plans include:
HMO Point of Service (HMOPOS) Plans
Medicare Medical Savings Account (MSA) Plan
What are some of the differences between Original Medicare and Medicare Managed Care?
There are many differences between Original Medicare and Medicare Managed Care plans. Here are some to consider:
Most Managed Care plans include prescription drug coverage while Original Medicare does not. Many seniors who choose Original Medicare add on a Part D plan to get prescription drug coverage.
Most Managed Care plans include additional health services such as vision, hearing and dental services while Original Medicare does not.
Some Managed Care plans offer additional services like transportation to doctors’ visits, fitness and wellness programs, and over-the-counter drugs. Original Medicare is not designed to cover these kinds of “extra” services.
Managed Care plans can be tailored to meet the needs of certain chronically-ill enrollees. *
Managed Care plans set a limit on annual out-of-pocket expenses to help protect seniors from unexpected costs, while Original Medicare does not. Note that some seniors with Original Medicare add on a Medigap plan to cover many of the out-of-pocket expenses they would otherwise incur.
With many Managed Care plans, seniors will need to receive services from in-network health care providers to ensure the lowest costs and some plans won’t cover services from providers outside the plan’s network and service area. Original Medicare can be accessed at standard Medicare rates through any participating health care provider across the U.S.
*Chronically-ill individuals can benefit greatly from speaking with a Medicare agent to discuss their options. Starting in 2021, people who are eligible for Medicare because they are diagnosed with end stage renal disease (ESRD) are now able to purchase a managed care plan. Previously, their only option was Original Medicare and Medicare Part D.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.