What is Medicare + Choice?



The Balanced Budget Act of 1997 established M+C also known as Medicare + Choice. M+C gives Medicare beneficiaries the alternative option to enroll in private plans such as HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), PSO’s (Provider Sponsored Organizations), or PFFS (Private Fee For Service). The purpose of this privatization of Medicare benefits was to take some of the stress off of the government administration of benefits and services to beneficiaries. It was also intended to give Medicare recipients alternatives which fit within their needs and budgets.

The rise and fall of Medicare + Choice

During the 1990’s the number of medicare recipients who chose to use the + Choice option and enroll in an HMO or PPO grew rapidly to more than 1 in 4 Medicare recipients, as did the number of M+C plans that were available. At the end of the 90’s into the beginning of the 2000’s the number of M+C plans fell by more than 50%. Since 1997 many changes have been made to encourage plans to stay in the Medicare market. The Balanced Budget Refinement Act of 1999 and the Benefits Improvement and Protection Act of 2000 raised payment amounts to M+C plans. Congress also eased some of the administrative requirements.

What does M+C have that I don’t have?

Though all of the alternatives are still offered by medicare the M+C HMO’s remain the preferred choice of Medicare beneficiaries. This is largely because HMO plans offer prescription drug benefits. Many HMO’s do place a cap, such as $750, on the amount of the prescription drug coverage allowed annually. Most Medicare + Choice users feel that this is better than no prescription coverage at all. Of all the alternative coverage plans offered by Medicare it would seem that the M+C plans offer seniors the best health care and prescription drug coverage under Medicare. If you are on Medicare it would be a good idea to check all of your options and choose the Medicare + Choice healthcare provider that fits best within your needs.



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