1. General

Official source

The MMA permits Medicare beneficiaries who are entitled to Part A and Part B to have their health care provided by an MA organization. An MA organization must enter into a contract with the Secretary of the Department of Health and Human Services (DHHS) to participate under Medicare.

An MA organization must provide members in its plan with coverage of the basic benefits by furnishing the benefits directly or through arrangements, or by paying for the benefits. Each MA organization must provide coverage of, through the provision of or payment for, all services that are covered by Part A and Part B of Medicare and that are available to beneficiaries residing in the plan’s service area.

In addition, the law permits MA organizations to offer plans that do not require members to receive services through a provider network (i.e. private fee-for-service plans, regional or local preferred provider organizations and some Medical Savings Account plans).

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1. General

Official source

The MMA permits Medicare beneficiaries who are entitled to Part A and Part B to have their health care provided by an MA organization. An MA organization must enter into a contract with the Secretary of the Department of Health and Human Services (DHHS) to participate under Medicare.

An MA organization must provide members in its plan with coverage of the basic benefits by furnishing the benefits directly or through arrangements, or by paying for the benefits. Each MA organization must provide coverage of, through the provision of or payment for, all services that are covered by Part A and Part B of Medicare and that are available to beneficiaries residing in the plan’s service area.

In addition, the law permits MA organizations to offer plans that do not require members to receive services through a provider network (i.e. private fee-for-service plans, regional or local preferred provider organizations and some Medical Savings Account plans).