Medicare Managed Care Greater Oversight Needed to Protect Beneficiary Rights

By Dummit, Laura A.

Book Id: WPLBN0000109444
Format Type: PDF eBook
File Size: 0.7 MB
Reproduction Date: 2005

Title:	Medicare Managed Care Greater Oversight Needed to Protect Beneficiary Rights
Author:	Dummit, Laura A.
Volume:
Language:	English
Subject:	Government publications, Accountability in government, United States. General Accounting Office
Collections:	Government Library Collection, Government Accountability Integrity Reliability Office Collection
Historic Publication Date:
Publisher:	United States General Accounting Office (Gao)


Citation APA MLA Chicago Dummit, L. A. (n.d.). Medicare Managed Care Greater Oversight Needed to Protect Beneficiary Rights. Retrieved from http://self.gutenberg.org/

Description
Government Accountability Integrity Reliability Office Collection

Excerpt
Excerpt: Since 1994, enrollment of Medicare beneficiaries in managed care has tripled to 7 million-comprising 18 percent of all Medicare beneficiaries. Beneficiaries who enroll in managed care are entitled to all Medicare-covered services. They also may benefit from lower out-of-pocket costs, additional covered benefits, and less paperwork than their counterparts in traditional fee-for-service Medicare. Unlike fee-for-service providers, however, managed care plans receive a fixed amount per month for each enrolled beneficiary, regardless of the type and number of services they provide. Consequently, plans have a financial incentive to limit beneficiaries? use of health care services. To safeguard access to appropriate covered services, Medicare allows beneficiaries to appeal-first to their managed care plans and then externally-whenever their health plans deny requested care or refuse to pay for services.