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Chapter 12. Medicare > Managed Care

Managed Care

Managed care sounds like it should be the best thing since sliced bread, but as George Carlin asks, “What’s so great about sliced bread?” The idea of managed care is simple. The health plan provider is paid a fixed monthly fee that covers all of the patient’s medical needs. That is a bargain for the managed care providers if the patient is healthy, but is costly to them if the patient is sickly and needs extensive and expensive medical services. With a Medicare managed care plan, the provider receives the fixed monthly fee from Medicare and the patient receives medical care without deductible payments and fewer copayments than usually required under the more traditional Medicare plans (if you can refer to anything that has only been around since 1965 as traditional). Since with a managed care plan you do not have as many of these extra out-of-pocket expenses for medical care, the need for a costly Medigap policy vanishes as well. So what is the catch?

In return for less costly medical care, you give up your right to pick the physician or physicians you wish to treat you. Managed care providers generally have limited lists of the particular physicians and hospitals that are within their network and from which you must choose.


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