Medicare Part C plans may provide for extra days of hospitalization.
The United States federal health insurance program known as Medicare, which is for seniors and the permanently disabled, has four distinctive parts -- Part A, Part B, Part C and Part D. Part A is hospitalization insurance that provides for assistance in inpatient care in hospitals, skilled nursing facilities, and certain home health care and hospice services. Part B pays for physician fees and medical supplies and services not covered under Part A. Part D is prescription drug coverage. Part C is a bit more complex.
Types of Part C Plans
Known as Medicare Advantage, Part C of the Medicare program offers additional health care insurance benefits to individuals enrolled in Part A and Part B of the program. The Social Security Administration divides the types of Medicare Advantage plans into categories and may refer to each in the official literature the agency issues by initials. According to the federal government, the four most common are PPO for preferred provider organization plans; HMO for health maintenance organization plans, also referred to as Medicare managed care plans; PFFS for private fee-for-service plans; and SNP for special needs plans, also known as Medicare specialty plans.
Common Part C Plans Defined
An HMO plan generally offers the enrollee a directory of participating hospitals and health care providers from which to choose. Once a primary physician is chosen, the doctor directs patient health care. A PPO is a pay-as-you-go plan. Health care providers that participate in the PPO network will have set fees for specific services. The patient has an option of choosing health care providers outside of the network but may be responsible for the difference, if any, in charges from the set fee schedule. PFFSs differ from other Medicare Part C plans in that the beneficiary can choose any qualified health care provider who agrees to take Medicare. SNPs are designed to provide needed services to Medicare-eligible individuals with severe chronic conditions, as well as disabled and institutionalized individuals.
Medicare Part C Providers
Providers of Medicare Advantage Plans are private insurance companies operating under agreed-to federal guidelines. Generally, insurers who offer Part C plans provide the consumer's Part A and Part B benefits as part of a package of coverage. According to the Social Security Administration, Medicare Advantage Plans must offer comparable Part A and Part B coverage for all benefits and services as the original Medicare program with the exception of hospice care. For patients who require hospices, the original Medicare insurance coverage kicks in.
Additional Program Requirements
Medicare literature stipulates that all eligible enrollees will be provided with coverage for emergency care, regardless of whether or not the patient has a Part C plan. Furthermore, the program stipulates that Part C plans are not considered supplemental coverage. In other words, the portions of the plans that mirror parts A and B should be identical or better than the original Medicare program, except as noted concerning hospice care. Part C then provides additional coverage, such as paying for extra days of hospitalization.
Tags: Part Part, health care, Medicare Advantage, care providers, Medicare Part, Medicare program
