12.6.3 Medicare Part C - Medicare Advantage
Due to the increase in eligible participants, Medicare's program and options have been revamped to include Medicare Part C (formerly known as Medicare+ Choice) and Medicare Part D (Prescription Drug Plan). A six-month initial enrollment period began on November 15, 2005 for both Part C and Part D.
You'll study Part D on the next page. Here, we'll address the particular options provided under Part C (Medicare Advantage).
Medicare Advantage specialty plans provide more focused health care for people with specific conditions. Persons who are enrolled in both Medicare Part A and Part B are eligible to join and receive health care services as well as provided specialty plans. These specialty plans provide services that focus care on the management of a specific disease or condition. However, these options are not designed to replace the need for long-term care insurance.
Preferred Provider Organizations
Preferred Provider Organizations (PPOs) who participate in Medicare coverage services operate similar to the PPO plans you've already studied except that a primary care physician (PCP) referral is not required for the participant to go outside the network.
Private Fee-For-Service Plans
The Private Fee-For-Service (PFFS) method of health insurance determines how much the covered individual must pay for Medicare-covered services (up to a limit). The beneficiary is responsible for paying the difference between the amount Medicare pays and the PFFS charges.
