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Federal Consumer Information Center Medicare Questions and Federal Consumer Information Center: Medicare - Questions and Answers

Section 2: Other Medicare Health Plans (continued)

Q: What are my out-of- pocket costs if I am enrolled in one of the new Medicare health plans?

A: Your out-of-pocket costs may depend on:

  • Which Medicare health plan you choose.
  • How often you need health care.
  • What type of health care you need.
  • Which extra benefits are covered by the plan.

Q: How can I find out which Medicare managed care plans are available where I live?

A: To find out which Medicare managed care plans are available where you live, you can call 1-800-MEDICARE (1-800-633-4227 or TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) for an up-to-date list. You can also look on the Internet at in the Medicare Compare section. Phone numbers for each available plan will be included in the information you will receive.

Q: How do I join / leave a Medicare managed care plan?

A: To join: Call the plan to request an enrollment form.

  • Complete the form, and mail it to the plan.
  • You will get a letter from the plan telling you when your membership begins.
  • The plan cannot refuse to enroll you.

To leave: Call the plan or the Social Security Administration (1-800-772-1213 or TTY/TDD: 1-800-325-0778) and tell them you want to disenroll. Your disenrollment becomes effective as early as the first day of the month after your request for disenrollment is received.

During 1999 and 2000 you can leave a plan at any time for any reason.

Caution: Special rules may apply if you choose to disenroll from a Medicare managed care plan and return to the Original Medicare Plan with a Medicare Supplemental Insurance (Medigap) Policy, or your employer’s health insurance policy (see pages 23- 25).

Q: What is the role of a primary care doctor in Medicare managed care plans?

A: Primary care doctors are trained to give basic care. In many Medicare managed care plans, they coordinate and give most or all of your health care. Many plans require you to see your primary care doctor for a referral to a specialist. When you join a Medicare managed care plan, you may be asked to choose a primary care doctor from among the doctors who belong to the plan. If you already have a doctor you would like to keep seeing, ask your doctor if he or she is in the plan and accepting new patients under that plan.

Q: May I change my primary care doctor if I am in a Medicare managed care plan? What if my primary care doctor leaves the plan?

A: You may change your primary care doctor. Check your health plan member handbook for instructions. You may also call the plan’s member services number. In some cases, the effective date of such a change may be the end of the current month. If your doctor leaves the plan, you may choose a new doctor in the plan.

Q: What is a referral?

A: A referral is permission from your primary care doctor to see a certain specialist or receive certain services. Some Medicare managed care plans may require referrals. Important: if you either see a different doctor than the one on the referral, or the service isn’t for an emergency or urgently needed care, you may be responsible for the entire bill.

Q: Can I leave a Medicare managed care plan and return to the Original Medicare Plan?

A: At the present time, you may disenroll from a Medicare managed care plan any time, for any reason. However, beginning January 1, 2002, disenrollment periods will be limited. To disenroll, give a signed written request to the plan, a Social Security Administration Office, or the Railroad Retirement Board. You must receive services from the plan until the date the plan tells you that you are disenrolled. Your Original Medicare Plan coverage can start as early as the first day of the month after your request is received.

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