About: Medicare Advantage

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Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expenses of enrollees. Insurers are allowed to vary the benefits from those provided by Medicare's other parts. Those who do not enroll in a Part C plan receive coverage for Part A and Part B services. Many purchase supplemental coverage (Medigap) to cover services not covered by Medicare, and enroll in Part D for coverage of prescription drugs.

Attributes	Values
rdfs:label	Medicare Advantage (en)
rdfs:comment	Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expenses of enrollees. Insurers are allowed to vary the benefits from those provided by Medicare's other parts. Those who do not enroll in a Part C plan receive coverage for Part A and Part B services. Many purchase supplemental coverage (Medigap) to cover services not covered by Medicare, and enroll in Part D for coverage of prescription drugs. (en)
foaf:homepage	https://www.cms.gov/
dcterms:subject	Medicare and Medicaid (United States) Managed care
Wikipage page ID	15404684 (xsd:integer)
Wikipage revision ID	1119930424 (xsd:integer)
Link from a Wikipage to another Wikipage	Capitation (healthcare) United States House of Representatives Congressional Research Service Medicare (United States) Legal Information Institute Preferred provider organization Prospective payment system Medigap Centers for Medicare and Medicaid Services Health maintenance organization Medicare and Medicaid (United States) Balanced Budget Act of 1997 Private sector Managed care Managed care United States Code Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Link from a Wikipage to an external page	http://www.agis.com/Eldercare-Basics/Legal-and-Financial/Medicare-and-Medicaid/ https://medicarepolicycenter.com/new-to-medicare/types-of-medicare-advantage-plans/ https://uscode.house.gov/browse/prelim@title42/chapter7/subchapter18/partC&edition=prelim https://www.law.cornell.edu/uscode/text/42/chapter-7/subchapter-XVIII/part-C http://www.kff.org/medicare https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ http://www.allhealth.org/issues.asp%3Fwi=7 http://kff.org/state-category/medicare/ http://health.howstuffworks.com/medicare.htm https://www.medicare.gov/ http://www.ssdrc.com https://archive.today/20130918113944/https:/opencrs.com/document/M20130326/ https://www.cms.gov/
sameAs	Medicare Advantage Medicare Advantage Medicare Advantage
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has abstract	Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expenses of enrollees. Insurers are allowed to vary the benefits from those provided by Medicare's other parts. Part C plans are required to offer coverage that meets or exceeds the standards set by the other parts, but they do not have to cover every benefit in the same way (actuarial equivalence is required). Plans must be approved by the Centers for Medicare and Medicaid Services (CMS). If a MA plan reduces some benefits, the savings may be passed along to consumers by lowering co-payments for doctor visits (or any other plus or minus aggregation approved by CMS). Coverage must include inpatient hospital (Part A) and outpatient (Part B) services. Typically, the plan also includes prescription drug (Part D) coverage. Many plans also offer additional benefits, such as dental coverage or gym membership. Such plans typically require a higher premium. Those who do not enroll in a Part C plan receive coverage for Part A and Part B services. Many purchase supplemental coverage (Medigap) to cover services not covered by Medicare, and enroll in Part D for coverage of prescription drugs. Most MA plans are managed care plans (e.g., PPOs or HMOs) with limited provider networks. About 40% of Medicare Advantage enrollees with prescription drug benefits pay an additional premium. MA plans typically include an annual out-of-pocket spending limit. Original Medicare and Medicare Advantage pay healthcare providers differently. Original Medicare typically reimburses healthcare providers with a fee for each service. This fee is often calculated with a standard formula (for example, the prospective payment system for hospital services). Providers either accept Medicare's reimbursement rates or opt out of the program. Medicare Advantage plans negotiate payment rates and form networks with healthcare providers, similar to other private health insurance plans. As of 2022, about 48% of Medicare beneficiaries were covered under Medicare Advantage plans. Nearly all Medicare beneficiaries have access to at least one Medicare Advantage plan; on average 39 plans per county were available. Medicare Advantage plan costs in 2008 averaged 12% more than Original Medicare. Other plan types, such as 1876 Cost plans, are available in some areas. Cost plans are not Medicare Advantage plans and are not capitated. Instead, beneficiaries keep their Original Medicare benefits while the plan sponsor administers their Part A and Part B benefits. The sponsor of a Part C plan could be an integrated health delivery system or spin-out, a union, a religious organization, an insurance company or other type of organization. (en)
gold:hypernym	United
prov:wasDerivedFrom	wikipedia-en:Medicare_Advantage?oldid=1119930424&ns=0
page length (characters) of wiki page	12747 (xsd:nonNegativeInteger)
foaf:isPrimaryTopicOf	wikipedia-en:Medicare_Advantage
is Link from a Wikipage to another Wikipage of	CareFirst BlueCross BlueShield CareSource Care Continuum Alliance America's Healthy Future Act Scott Flanders Scott Gottlieb List of acts of the 114th United States Congress Mount Carmel Health System Private exchange 2020 in Puerto Rico Bright Health Annual enrollment Humana Better Medicare Alliance UnitedHealth Group Universal American Independent Payment Advisory Board Consumers' Checkbook Council for Affordable Quality Healthcare MatlinPatterson Medicare (United States) Mehmet Oz SCAN Health Plan Cigna Clover Health Elijah Cummings Lower Drug Costs Now Act GoHealth Medicare Part D Medicare Payment Advisory Commission Medicare dual eligible Bankers Life Banner Health Barack Obama CARES Act WellCare Health insurance in the United States Healthcare reform debate in the United States James C. Robinson (health economist) AARP AHIP (trade association) AdvoCare Aetna Affordable Care Act American Medical Group Association DaVita Inc. EHealthInsurance Fast Healthcare Interoperability Resources Balanced Budget Act of 1997 Partnership HealthPlan of California Fallon Health United States federal budget

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