Saturday Quiz

Designed to enlighten and amaze

 

True or False

There are some Medicare Advantage plans that don’t require the selection of a PCP or referrals for care.

The astonishing answer below:

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Answer: True

There are two types of Medicare Advantage plans: Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPOs).

PPOs don’t require the beneficiary to select a primary care provider (PCP) and don’t require referrals for specialist visits.

PPOs are paid the same way as HMOs, except the monthly payments from the government go to the insurer rather than a PCP.

Because they rely on the insurer to control costs rather than an “on-the-ground” PCP, they tend to pay clinicians and facilities at poor rates, limiting their networks and making them unattractive to beneficiaries.

Bottom line:  Avoid PPOs.  Nobody wins, not even the insurance company.