Most managed care plans allow you to select a primary care physician from those who participate in the plan. You have the right to change your primary care physician at any time, but you must choose from among those doctors who are part of your HMO plan.

What does the "lock-in" provision mean?

It means that you are required to receive all covered services through the HMO plan. Important: Neither the HMO nor Medicare will pay for care received outside the HMO network, unless the HMO has referred you to that provider.

Who reviews the quality of care?

Quality and cost effectiveness are monitored by the federal government (HCFA), state licensing authorities (departments of Health and Insurance), and by KePRO, Pennsylvania's Medicare contracting Peer Review Organization (PRO). The role of KePRO is to make certain that those covered by Medicare or Medicare HMOs are able to receive professional care that meets the set standards.

The performance of HMO plans and individual providers is monitored by government supervision, patient satisfaction surveys, and information obtained from reported complaints, as well as independent reviews which sometimes issue "report cards" on HMOs.

In addition, HMOs may participate in a voluntary national accreditation program which requires them to meet certain standards. You can find out if the plan you're considering or have already joined has been accredited by calling the National Committee for Quality Assurance (NCQA) at 1-202-955-3500 or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) at 1-708-916-5800.

Do I still pay my Medicare Part B premium?

Yes, you must continue to participate in Medicare Part B and pay the monthly premium, even if you are enrolled in a "zero premium" HMO plan.

care and

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