The managed Medicare lexicon

Monday, March 31, 2003


In most plans, you can only go to doctors, specialists, or hospitals on the plan’s list. Plans must cover all Medicare Part A and Part B health care. Some plans cover extras, like prescription drugs. Your costs may be lower than in the Original Medicare Plan.

HMO (health maintenance org.)

A type of Medicare managed care plan where a group of doctors, hospitals, and other healthcare providers agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. In an HMO, you usually must get all your care from the providers that are part of the plan.

PPO (preferred provider organization)

A managed care plan in which you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Private fee-for-service

A private insurance plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it pays and what you will pay for the services you will get. You may pay more for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan does not cover.

POS (point of service)

An HMO managed care plan that lets you use doctors and hospitals outside the plan for an additional cost.