health care prepayment plan (HCPP)

Type of managed care organization that contracts with Centers for Medicare and Medicaid Services (CMS) to provide Medicare-eligible Part B medical services to enrollees. In return for a monthly premium, plus any applicable deductible or copayment, all or most of an individual’s physician services are provided by the HCPP. The HCPP pays for all services it has arranged for (and any emergency services) whether provided by its own physicians or its contracted network of physicians. If a member enrolled in an HCPP chooses to receive services that have not been arranged for by the HCPP, he or she is liable for any applicable Medicare deductible and/or coinsurance amounts, and any balance would be paid by the regional Medicare carrier.

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