Before you get pushed into a healthcare plan, it is vital to understand the major differences between your choices. In this short, we look closely at a significant downside of Medicare Advantage plans: managed care.
When you choose a Medicare Advantage plan, your healthcare is overseen by a private insurance company. This means that if you need major surgery or a specialized treatment plan, your doctor often has to go to the insurance plan first and ask for permission before they can proceed with your care.
Frequently Asked Questions (FAQ)
– What does managed care mean in a Medicare Advantage plan?
Managed care means the insurance company controls costs by utilizing a specific network of doctors and hospitals. It also means the provider must follow the company’s guidelines for approving certain medical procedures, tests, or specialist visits.
– Why do Medicare Advantage plans require prior authorization?
Medicare Advantage plans require prior authorization (or permission) to ensure that a requested medical service or prescription drug is deemed medically necessary by the insurer’s standards before they agree to cover the cost.
– Does Original Medicare require permission for surgeries and treatments?
Generally, no. Original Medicare does not use a managed care model. As long as your doctor accepts Medicare and determines a treatment or surgery is medically necessary, you do not have to wait for an insurance company’s prior approval to receive care.
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