{"id":355793,"date":"2016-04-04T10:46:14","date_gmt":"2016-04-04T15:46:14","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/healthcare\/medicare-medicaid\/medicare-tips-for-picking-a-managed-care-plan.html"},"modified":"2025-09-09T16:57:53","modified_gmt":"2025-09-09T21:57:53","slug":"medicare-tips-for-picking-a-managed-care-plan","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-tips-for-picking-a-managed-care-plan.html","title":{"rendered":"How to Pick a Medicare Advantage Managed Care Plan"},"content":{"rendered":"\n
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Medicare Advantage Plans vs. Original Medicare: A Comprehensive Guide<\/h1>\n\n
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\n By Lyle Therese A. Hilotin-Lee, J.D.<\/a> | Legally reviewed by Jordan Walker, J.D.<\/a>\n | Last updated\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n\n\n

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To choose and enroll in a Medicare Advantage managed care plan, evaluate your healthcare needs, budget, and provider preferences. You can do this\u00a0by comparing each health insurance plan’s network,\u00a0coverage extras\u00a0like dental and vision, drug benefits, and annual out-of-pocket limit. Consider whether to\u00a0prioritize lower predictable costs or wider provider choice, as\u00a0Medicare Advantage offers bundled coverage but often comes with network restrictions.<\/i><\/p>\n\n <\/div>\n\n\n\n

Medicare Advantage managed care plans are private insurance alternatives to original Medicare that provide Part A and Part B benefits through an approved insurer. Many plans also include extra benefits such as dental, vision, or hearing coverage.<\/p>\n\n\n\n

Medicare provides an essential health insurance plan for people at least 65 years old. Choosing between traditional Medicare and Medicare Advantage can feel confusing. Medicare Advantage and Original Medicare have different features, and it’s crucial to understand these differences before making a decision on which plan you’ll enroll in as a Medicare beneficiary.<\/p>\n\n\n\n

If you have questions about Medicare or are dealing with issues related to healthcare coverage, contact a healthcare attorney<\/a>. They can help you understand your healthcare coverage and provide additional information about your options.<\/p>\n\n\n\n

Medicare Plans A, B, C, and D: Overview<\/h2>\n\n\n\n

Most people associate traditional Medicare with two main plans. These are Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Part A covers hospital stay, critical access hospitals, skilled nursing facilities, hospice care, and some home healthcare services.<\/p>\n\n\n\n

Most people who are already receiving Social Security or Railroad Retirement benefits are automatically enrolled in Part A at age 65. Others may need to sign up with Social Security.<\/p>\n\n\n\n

Part B (medical insurance) covers outpatient hospital care that Part A may not cover. This includes physical therapy and some home health care when it is medically necessary. As of 2025<\/a>, the standard Part B premium is $185 per month, although higher-income beneficiaries may pay more due to income-related adjustments.<\/p>\n\n\n\n

Medicare Advantage vs. Managed Care<\/h2>\n\n\n\n

Most Medicare Advantage plans function as managed care organizations, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), but there are also other types like private fee-for-service and medical savings account plans.<\/p>\n\n\n\n

Managed care is a healthcare system in which insurance companies work with a network of providers, such as hospitals and doctors. Through this system, the insurance company manages the costs and chooses the network that you can work with as plan members.<\/p>\n\n\n\n

Medicare Advantage\u00a0vs.\u00a0Traditional Medicare<\/strong><\/h2>\n\n\n\n

Understanding the essential differences between Medicare Advantage and Traditional Medicare<\/a> can help you decide which option fits your needs. Let’s see what each has to offer.<\/p>\n\n\n\n

Traditional Medicare Coverage<\/h3>\n\n\n\n

Original Medicare<\/a> consists of hospital coverage (Part A) and medical services coverage (Part B). With Original Medicare, you can see any medical provider or hospital nationwide that accepts Medicare. You also don’t need preauthorization to see specialists and can access out of network providers more easily.<\/p>\n\n\n\n

Original Medicare does not include Medicare drug coverage (Part D), so you will need to purchase this plan separately. You can also add Medicare Supplement Insurance (Medigap) to help you cover other costs.<\/p>\n\n\n\n

Medicare Advantage Managed Care<\/h3>\n\n\n\n

The majority of Medicare<\/a> Advantage Plans cover prescription drug benefits. Medicare Advantage Plans also offer additional healthcare services not included in Original Medicare, such as dental, vision, and hearing care. It generally provides a more comprehensive health benefit. Many plans work as either a HMO or Preferred Provider Organization (PPO).<\/p>\n\n\n\n

Determining Which Medicare Plan Fits Your Needs: Medicare Advantage and Original Medicare<\/strong><\/h3>\n\n\n\n

When deciding between these coverage options, consider your healthcare needs, financial situation, and personal circumstances. Your potential future long term care needs should also factor into your decision. <\/p>\n\n\n\n

Original Medicare Might Work Better if You:<\/h3>\n\n\n\n