Plans

Full Capitation refers to a healthcare payment arrangement where services are reimbursed through a combination of capitated payments and fee-for-service reimbursements. 🧠 Full Definition Full Capitation is a managed care payment model in which a health plan or Primary Care Case Manager (PCCM) … [Read more...] about Full Capitation

Free-Look Medigap Policy refers to a trial period that allows beneficiaries to review and cancel a Medigap policy for a full refund if they change their mind. 🧠 Full Definition A Free-Look Medigap Policy period is a limited review window, typically lasting 30 days, during which a beneficiary … [Read more...] about Free-Look Medigap Policy

Fee-for-Services refers to a healthcare payment arrangement where plans or providers are reimbursed based on individual healthcare services delivered to enrollees. 🧠 Full Definition Fee-for-Services is a healthcare reimbursement model in which a plan or Primary Care Case Management (PCCM) … [Read more...] about Fee-for-Services

Deemed Provider refers to a healthcare provider that agrees to follow the payment terms and conditions of a Private Fee-for-Service Medicare plan before delivering services. 🧠 Full Definition A Deemed Provider is a healthcare provider that knowingly accepts a patient enrolled in a Private … [Read more...] about Deemed Provider

Cost-Based Health Maintenance Organization is a type of managed care organization that provides coordinated healthcare services in exchange for monthly premiums and applicable cost-sharing requirements. 🧠 Full Definition A Cost-Based Health Maintenance Organization (HMO) is a managed care … [Read more...] about Cost-Based Health Maintenance Organization

Coordinated Care Plan is a Medicare plan that uses a CMS-approved provider network to deliver covered healthcare services through coordinated care arrangements. 🧠 Full Definition A Coordinated Care Plan is a type of Medicare health plan that operates through a CMS-approved network of … [Read more...] about Coordinated Care Plan

Comprehensive MCO refers to a managed care organization that provides comprehensive healthcare services to commercial, Medicare, and Medicaid enrollees. 🧠 Full Definition A Comprehensive MCO is a Managed Care Organization that delivers broad healthcare services through a managed care … [Read more...] about Comprehensive MCO

Commercial MCO refers to a managed care organization that provides comprehensive healthcare services to commercial, Medicare, and Medicaid enrollees. 🧠 Full Definition A Commercial MCO is a Managed Care Organization that operates under Medicare, Medicaid, or commercial health insurance … [Read more...] about Commercial MCO

Plan Benefits Description explains the scope, terms, conditions, and limitations associated with healthcare coverage provided under a Medicare plan. 🧠 Full Definition A Plan Benefits Description outlines the details of healthcare coverage offered under a Medicare plan, including the services … [Read more...] about Plan Benefits Description

Medigap Basic Benefits are the core standardized benefits included in Medigap Plan A and carried across all standardized Medigap plans. 🧠 Full Definition Medigap Basic Benefits refer to the foundational coverage protections included in Medigap Plan A, which serves as the baseline standardized … [Read more...] about Medigap Basic Benefits