Medicare Part C

(redirected from Medicare + Choice)

Medicare Part C

An optional Medicare program (US) created under the Balanced Budget Act of 1997, which gives Medicare beneficiaries the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). Medicare Advantage plans are offered through private companies known as Medicare Advantage Organizations (MAOs); each company under contract with the Centers for Medicare and Medicaid Services (CMS) is required to provide an effective compliance program to prevent Fraud, Waste and Abuse issues in healthcare settings. For individuals who choose to enroll in a Part C plan, Medicare pays the private plan a fixed amount every month; members also pay a monthly premium over and above the Medicare Part B premium to cover items not covered by Medicare Parts A & B (e.g., prescription drugs, dental care, vision care and health club memberships).

Medicare Part C

A component of Medicare that gives beneficiaries the option of receiving health care from privately managed health plans.
References in periodicals archive ?
The long-suffering Medicare + Choice program may be stabilizing to some degree, CMS Administrator Tom Scully says.
GAO was asked to determine (1) the extent to which beneficiaries received recommended preventive services through existing visits, (2) whether approaches used by Medicare + Choice plans provide insight for improving delivery of preventive care services for fee-for-service beneficiaries, and (3) what the Centers for Medicare & Medicaid Services (CMS) is doing to explore suggested options for delivering preventive care to fee-for-service beneficiaries.
President Bush reportedly wants to reinvigorate the Medicare + Choice program by requiring future Medicare enrollees to participate in one of the managed-care plans.
ALTHOUGH THERE IS NO UNIFORM NATIONAL APPEAL PROCESS in place for managed care plans outside of Medicare, there is and has been for more than 10 years an appeal process that provides dissatisfied Medicare beneficiaries enrolled in Medicare + Choice Organizations (M+COs), including HMOs and PPOs, with recourse for denials of access to care or reimbursement for services already rendered.
The agency thought the legislation would bring about an increase in the number of Medicare + Choice plans, not to mention improvements through competition and increases to market penetration (currently about 15 percent of all Medicare eligibles).
Peck: Will the Medicare + Choice program scheduled to go into effect next year offer nursing homes a reasonable managed care alternative to PPS?