MAKING AN EDUCATED CHOICE

o select the best Medicare

option for you, you need to do your homework. Don't base

your choice on cost alone, and don't rely solely on the

plan's glossy marketing piece for plan information. CPAs

recommend that you request a complete written explanation

of the plan's coverage, costs, and rules. It's also a

good idea to talk to family members and friends about

their experiences with plans available in your area. Here

are some of the factors you should consider.

BENEFITS AND COSTS

Your first step is to

determine what the plan covers and how much it will cost

you to get the services you want. In addition to covering

all the services available under Medicare's original

fee-for-service plan, managed care plans typically

emphasize preventive care.

Some managed care plans

charge a premium in addition to the Medicare Part B

premium, while others do not. Find out the cost of

monthly premiums and what co-payments you will be

expected to pay. Be sure to consider added benefits as

well as hidden costs. Some Medicare managed care plans

offer benefits that are not covered by Medicare's

fee-for-service program, including some prescription drug

coverage, vision care, hearing aids, and dental care. If

these are services you typically use and pay for, take

those costs into account in making your decision. In

terms of hidden costs, it's important for you to be aware

that, depending on the type of managed care plan you

select, should you choose to see a doctor outside the

plan's network, you may have to pay for all or some of

that care yourself.

DOCTORS AND HOSPITAL

First, find out what

doctors are in the plan and what percentage are board

certified. The more doctors who are board certified,

meaning they successfully passed an examination given by

a medical specialty board, the better.

There are several varieties

of managed care plans. Some are severely restrictive when

it comes to seeing providers from outside the network and

consulting with specialists. Others give members more

freedom to get care from doctors or hospitals that are

not part of the plan's network. Generally, more choice

translates into higher cost.

In many managed care plans,

and particularly in Medicare HMOs, you will be asked to

select a primary care physician, generally a family

practice doctor or an internist, who directs your care.

Your PCP provides you with basic health care services,

coordinates your care, and refers you to specialists when

he or she determines it is medically necessary.

If you're selecting a

managed care plan based on your current doctor's

participation, you should be aware that the plan's rules

may require your doctor to handle your treatment

differently once you join the plan. For example, as a

managed care patient, you may not be able to get the same

prescription drugs you're using now. Discuss this with

your doctor before making the switch.

QUALITY OF CARE

While the quality of care

is the most important feature of any managed care plan,

assessing that quality is a relatively new field. The

National Committee for Quality Assurance is a private,

not-for-profit organization that assesses and reports on

the quality of managed care. You can check a managed care

plan's accreditation status by calling NCQA at

1-888-275-7585 or by inquiring at its Website,

www.ncqa.org.

Good Medicare managed care

plans can save you money and give you reliable care, but

making a change in the way you receive and pay for

healthcare should not be taken lightly. You may want to

consult with a CPA who can analyze your medical needs,

financial situation, and personal values to help you

select a plan that meets your needs.