This is accomplished in a number of ways, including contracts with specific providers, incentives to those providers to keep costs down and a review process to prevent the use of unnecessary health services. A type of Medi-Cal plan in which participants select primary care physicians to serve as gatekeepers to manage all care provided. Medicare part Part A provides benefits for hospitalization, home health care, hospice and skilled nursing facility services. Medicare Part B provides benefits for physician services, medical supplies and other outpatient care. An alternative to traditional Medicare coverage in which patients assign their Medicare benefits to health plans that receive monthly premiums from the federal Health Care Financing Administration.
Care is provided like HMOs with gatekeepers or primary care physicians coordinating care.
Seniors elect these plans to eliminate the paperwork and deductibles associated with Medicare. The health plans offer the same benefits as Medicare and often additional benefits such as prescription coverage as incentives to enroll. A health plan that offers the option to either coordinate care through a primary care physician or seek medical care from another provider. As with a health maintenance organization, the patient is responsible for a nominal copayment. The patient is generally responsible for a deductible and for paying a percentage of the bill.