| Mon, Nov 08, 2010 @ 09:00 AM

Medicare Part C (Medicare Advantage) Coordinated Care Plans

Posted by Medicare Made Clear

Medicare Coordinated Care PlansThere are many options available when it comes time to choose your Medicare coverage.  To encourage competition, Medicare gives the private insurance companies that offer Medicare Advantage Part CPlans flexibility in setting the terms of each plan. That means you will find variation among the plans as you shop. If you are considering a Medicare Part C plan, here are a few important things to know.

1)       Coordinated Care Plans combine Parts A and B – and sometimes Part D.

Medicare Advantage coordinated care plans offer one-stop shopping for all your health care. They combine all of the care covered by Part A and B (except for hospice care, for which you can still receive coverage under Medicare Part A), but they also include additional care designed to help you stay healthy. Some plans offer nurse help-lines and other resources that can help you take a more active role in your health care. Many plans offer prescription drug coverage, too.

2)       How do coordinated plans differ from Medicare Parts A and B?

These plans are called coordinated care plans because they are built on the idea of a network of doctors and hospitals together to provide care. These plans usually take a broader view of your care that Parts A and B do. Plan networks also work to improve the quality of care through management techniques for the providers in the network.

Unlike Parts A and B, these plans have some limits on your choice of doctors and hospitals.  The limits will depend on your type of plan.

3)         There are four different types of Medicare Advantage Coordinated Care Plans.

In a HMO (Health Maintenance Organization) type of plan, you must use doctors that belong to the plan or go to hospitals in the network for your care. If you go outside the network for care, other than emergency care, urgent care, or out-of-area renal dialysis, you must pay for your own care. These plans may require you to choose a primary care physician. In some plans, you may need a referral from this physician to see a specialist.

A POS (Point of Service Plan) is a type of HMO plan that allows you the ability to visit doctors and hospitals outside your network for some covered services, usually for a higher copayment or coinsurance. Some POS plans do not require referrals for specialty services.

In a PPO (Preferred Provider Organization) type of plan, you are likely to have more freedom to choose your doctor. These plans typically don’t require you to have a referral to see a specialist and you can see doctors outside the network without having to pay the entire cost yourself. However, if you do visit a doctor or hospital out side the network, you’ll usually pay a larger share of the cost.

Special Needs Plans are a type of coordinated care plan designed for people with specific needs. They combine hospital care and doctor’s visits and other outpatient care in a single plan. Because people who qualify for Special Needs Plans often need a considerable amount of medical care, these plans usually focus on helping members receive well-coordinated care. Special Needs Plans may serve people in any of these groups:

a.       People who are institutionalized in a nursing home or other long- term- care facility because they cannot care for themselves

b.       People who are eligible for both Medicare and the Medicaid assistance program

c.       People with certain chronic diseases such as diabetes or heart disease

4)       Networks Can Change

The doctors and hospitals that are in your network can change from year to year. Be sure to review your plan each year, during or before the annual election period, to ensure that your doctors and hospitals remain within your network.

Interested in Learning More about Medicare Part C Coordinated Care Plans?

Contact your local Social Security Office to learn more about the plans available in your area. For more details download our easy-to-use reference guide for understanding Medicare at MedicareMadeClear.com or call the Medicare Helpline at 1-800-MEDICARE (TTY 1-877-486-2048) 24 hours a day, 7 days a week.

Additional Resources




The family of UnitedHealthcare® Medicare Solutions plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization with a Medicare contract and Medicare-approved Part D Sponsor.

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