How does a Medicare Part C managed care plan work?

Medicare Part C managed care plans are required to cover any medical service that would be covered under Medicare Part A and Part  B. Also, many Medicare managed care plans add some coverage (though usually not much) that isn't covered by Part B. Each plan decides what extras it will offer

With Medicare Part C HMO plans, there are important restrictions on how you get your care:

    * To get coverage from a Medicare Part C HMO plan, you can obtain care only from doctors, hospitals, and other healthcare providers who belong to the HMO's official "network" -- meaning providers who are under contract with the HMO.
    * A Medicare Part C HMO plan won't pay for care by a specialist unless referred by your HMO-network primary care physician.
    * Under a Medicare Part C HMO plan, you might not be covered for certain kinds of care unless the plan approves that care in advance.
    * You have limited rights to appeal a decision made by the Medicare Part C plan with regard to the care they won't cover.

Two other types of Medicare Part C managed care plans, slightly different from HMOs, are available in some places. One is an HMO plan with a point-of-service (POS) option; the other is a preferred provider organization (PPO) plan. With either of these Medicare Part C plans, you can see a provider outside the plan's network, or see a specialist without first getting a referral -- but the plan will pay a smaller amount of the bill. These plans are less common than Medicare Part C HMOs and might not be available where you live.

Contact Oregon E Health for your Group & Individual Health Insurance needs in Portland & to have your Medicare Advantage/Medicare Supplement questions.