Medicare part C

Medicare Part C Medicare Part C or Medicare + Choice is a set of healthcare options created by the BBA to give Medicare beneficiaries more choices in healthcare and contractors. A Medicare beneficiary may choose to have covered items and services furnished to him or her through another plan, rather than traditional Medicare. Medicare + Choice plans include:

Health Maintenance Organization (HMO)
Point of Service option (POS)
Provider Sponsored Organization (PSO)
Preferred Provider Organization (PPO)
Private fee-for-service plan (PFFS)
Religious fraternal benefit society plan (RFB)

To participate in the Medicare Program, a Medicare managed care plan must have a contract with the Secretary of DHHS. It must provide the same services a beneficiary would be eligible to receive from Medicare if he or she were not a managed care plan enrollee. In other words, the beneficiary still technically “ has Medicare ” but has selected a different contractor and is required to receive ser- vices according to that contractor ’ s arrangements.

The beneficiary ’ s entitlement to Medicare is based on the same criteria, whether healthcare expenses are payable by an HMO or traditional Medicare carriers and/or fiscal intermediaries. The four types of election periods in which Medicare beneficiaries may enroll or disenroll from a Medicare managed care plan are as follows:

The annual election period, which occurs November 15 through December 31 each year.

The initial coverage election period, which begins three months immediately before entitlement to Medicare Part A or enrollment in Part B and ends three months after entitlement.

The special election period, (granted in certain situations) to allow beneficiaries to change Medi- care + Choice plans or to return to Original Medicare.

The open enrollment period, which runs from January 1 through December 31 of each year through 2004, if the health plan is open and accepting new members.

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