Medicare Managed Care


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NASL 2020 Issue Briefs:

NASL 2020 Legislative Priorities and Fact Sheet

2021 Cuts to Medicare Part B Programs Reduce Beneficiaries’ Access to Care

LTPAC Health IT Essential To Achieving Efficient, Effective Healthcare System


Benefits of a New Payment Model for Clinical Laboratory Services Provided to Nursing Home or Homebound Patients

Novitas Reimbursement Reduction Poses Huge Risk for Medicare Beneficiaries and Suppliers of Portable X-Ray Services

Hospital Observation Status Harms Beneficiaries’ Access to Medicare’s Skilled Nursing Benefit

Expand Telehealth Services for Medicare Beneficiaries

The Balanced Budget Act of 1997 (BBA) established a new Part C of the Medicare program, known then as the Medicare+Choice (M+C), effective January 1999. As part of the M+C program, the BBA authorized CMS to contract with public or private organizations to offer a variety of health plan options for beneficiaries, including both traditional managed care plans (such as those offered by HMOs under §1876 of the Social Security Act) and new options that were not previously authorized. Four types of M+C plans were authorized under the new Part C of Medicare:

  • Coordinated care plans, including:
    • Health Maintenance Organizations (HMOs) (with or without Point-ofService options (POS));
    • Provider Sponsored Organizations (PSOs) and 
    • Preferred Provider Organizations (PPOs);
  • Medicare Medical Savings Account (MSA) plans;
  • Private Fee-for-Service (PFFS) plans; and
  • Religious Fraternal Benefit (RFB) plans.

Medicare Managed Care Manual

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