I think we've all heard that Medicare Part D is the government's healthcare plan for medications. Most people by now have heard that, but what is Medicare Part C? Actually very few people know this one.
It is the government's answer to Managed Care. It is their Senior Risk HMO plan. What does that mean? Well, if you are enrolled in Medicare, and want to choose to go to one certain provider (let's say Kaiser) then you can select them to be your provider. At that point the government will pay Kaiser a stipend each month whether you have been seen or not. This is to cover you expenses for when you are seen. The main idea being that a healthy population will make up for the (hopefully smaller) sick population. As long as you have more healthy people than sick people, you can stay in the black for this. However you need to be aware that several terminally ill patients can turn your profit margin into a negative. Consider this carefully.
From the patient's standpoint, it is a good idea. The main problem that I have run into is them misunderstanding what their coverage actually is. In the example above, many people will think they have both Medicare and Kaiser. There is a lack of understanding that under Medicare Part C, you choose one or the other, but it is not both. You will still have to make your copay, and pay your deductible when appropriate. It won't be billed to the other carrier.
So there you have it. Medicare Part C in a nutshell.
Until next time,
Author Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.