What is the role of restricted network provisions in Medicare Select policies?

The role of restricted network provisions in Medicare Select policies is primarily to limit the choice of providers. Medicare Select is a type of managed care plan that requires beneficiaries to use a specific network of doctors and hospitals in order to receive full benefits. This creates a situation where members must choose providers from a designated network to avoid higher out-of-pocket costs or reduced coverage. By doing so, the plan can negotiate lower premiums and provide services at a reduced cost to both the insurer and the insured.

Beneficiaries who choose to seek care outside of this network may face higher costs or may not be covered at all for those services. This structure is designed to encourage individuals to use the network providers, which helps to manage costs within the Medicare program.

While other choices may seem relevant, they do not accurately describe the primary function of restricted network provisions. For example, providing additional benefits for out-of-network services contradicts the very essence of the network restrictions by implying that out-of-network care would be incentivized. Defining eligibility for preventive services does not directly relate to the restriction of provider choice, which is the core concept here. Likewise, providing coverage for all services regardless of network runs counter to the purpose of a selective network plan. Thus, focusing on limiting