Alphabet soup options can confuse patients
August 1, 1998 2 minutes read
Alphabet soup options can confuse patients
Under the new Medicare+Choice rules, both providers and beneficiaries have a new list of options they can choose from to give and receive health care.
It can be difficult for support staff and patients to distinguish among the ever-growing number of options. We've put together a cheat sheet for physicians, patients, and staff members to use to help keep track of the choices available to them. These choices include:
1. Health maintenance organizations (HMOs). In HMOs, beneficiaries must obtain services from a designated network of doctors, hospitals, and other health care providers who have agreed to serve plan enrollees, usually with little or no out-of-pocket payment.
2. HMOs with a point-of-service (POS) option. When combined with a basic HMO package, the POS permits beneficiaries to selectively go out of network to receive services, with higher out-of-pocket payment requirements.
3. Preferred provider organizations (PPOs). Beneficiaries in PPOs obtain services from a network of health care providers that has been set up by the health plan. Unlike an HMO, beneficiaries can choose to go to providers who are not in the network, and the plan will pay a percentage of the costs while the beneficiary is responsible for the rest.
4. Provider-sponsored organizations (PSOs). PSOs are a relatively new form of managed care that work much like an HMO, except that they are formed by a group of hospitals and doctors who directly take on the financial risk of providing comprehensive health benefits for Medicare beneficiaries.
5. Private fee-for-service plans. A Medicare beneficiary elects a private indemnity-type insurance plan. The insurance plan, rather than the Medicare program, decides how much to reimburse for services provided. Medicare pays the private plan a premium to cover traditional Medicare benefits. Providers are allowed to bill beyond what the plan pays (up to a limit), and the beneficiary is responsible for paying whatever the plan doesn't cover. The beneficiary also may be responsible for additional premiums.
6. Medical savings accounts (MSAs). Congress has authorized up to 390,000 Medicare beneficiaries to participate in an MSA demonstration. The beneficiary chooses a Medicare MSA Plan - a health insurance policy with a high deductible. Medicare pays the premium for the MSA Plan and makes a deposit into the Medicare MSA that is established by the beneficiary. The beneficiary uses the money in the Medicare MSA to pay for services provided before the deductible is met, and for other services not covered by the MSA Plan.
7. Medicare MSA plan. Unlike other Medicare+Choice options, individuals who enroll in MSAs are locked in for the entire year, with a one-time option of withdrawing by Dec. 15 of the year in which they enrolled.
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