Health · Chapter 17 · Parts C & D
Medicare Part C: Medicare Advantage
Definition
Private, Medicare-approved plans replacing Original Medicare (must cover everything A+B does; usually adds drugs/dental/vision). Requires enrollment in A AND B (keep paying the B premium), living in the service area. Types: HMO (referrals, network-only) · PPO · PFFS (any Medicare-approved provider who accepts the plan) · SNP (chronic conditions, dual-eligibles, nursing-home residents). CMS pays plans a fixed monthly capitated amount per enrollee (based on plan bids against county benchmarks, risk-adjusted).
Exam tip
MA + Medigap can NEVER coexist — selling Medigap to an MA enrollee is prohibited. Joining an MA plan (except drug-less PFFS/MSA plans) cancels a stand-alone Part D plan.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
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