Traditional Fee-For-Service Medicare Plans
Traditional Medicare coverage, called ‘fee-for-service’ because healthcare providers bill Medicare each time they provide a service, has three components:
- Part A covers inpatient care in hospitals and skilled nursing facilities, plus home health and hospice services
- Part B covers outpatient and primary care services, including physician and clinical lab services, preventive care, some health screenings, surgical fees and supplies, physical and occupational therapy
- Part D, which was added in 2003 under President George W. Bush, covers prescription drugs
Medicare Advantage Plans Offer Additional Benefits
In 1997, Congress passed a law that created Medicare+Choice plans or Part C plans. In 2003, these became known Medicare Advantage Plans. Medicare Advantage Plans provide a more coordinated approach to healthcare for older Americans than does traditional, fee-for-service Medicare and typically provide additional benefits that include:
- The convenience of receiving all of your medical coverage from one source
- Less expensive premiums
- Additional benefits that may include wellness services, dental and vision care
Medicare Advantage Plans cover all of the services offered in Parts A and B. Many Advantage Plans also cover Part D (prescription) services as well as additional services. Today, about one third of all people covered by Medicare participate in an Advantage Plan.
Medicare Advantage plans are offered by private companies like Provider Partners Health Plans (PPHP) that contract with Medicare to provide all of your Part A and Part B benefits. These Advantage Plans have specific rules that determine who is eligible and that require members to use participating providers.
Special Needs Plans for Special Populations
Different Medicare Advantage programs are available for different populations. In 2003, Congress created Special Needs Plans to improve care for the most vulnerable Medicare beneficiaries – those with special needs as the result of such problems as dementia, diabetes or stroke, or those who are in skilled nursing facilities. Learn more about Special Needs Plans and the PPHP difference.
Page Last Updated: 10/15/2021