Type of Medicare Advan- tage Plan that is available in some areas of the United States. In most of these plans, the member can only go to doctors, specialists, or hospitals on the plan’s list. Plans must cover all Medicare Part A and Part B health care. Costs to the member may be lower than in the Original Medicare Plan.

Type of Medicare health plan that is made up of two parts. One part is a Medicare MSA health insurance policy with a high deductible, and the other part is a special savings account where Medicare deposits money to help the insured pay the medical bills.

Hospital benefits of a nationwide health insurance program for persons age 65 years and older and certain disabled or blind individuals regardless of income, administered by Centers for Medicare and Medicaid Services (CMS), formerly HCFA. It was established by §1811 of Title XVIII of the Social Security Act of 1965. Local Social Security offices take applications and supply information about the program. Benefits include hospital, nursing home, hospice, home health, and other inpatient care. Insurance claims are transmitted to fiscal intermediaries for payment. Ten regional offices provide CMS with a decentralized administration and delivery of Medicare programs. Each regional office oversees private insurance companies that contract with the government to process and pay for Medicare Part A benefits. Medicare hospital insurance is also referred to as “HI.”

Medical insurance that is a nationwide health insurance program for persons age 65 years and older and certain disabled or blind individuals regardless of income, administered by the Centers for Medicare and Medicaid Services (CMS), formerly HCFA. It was established by §1831 of the Title XVIII of the Social Security Act of 1965. Local Social Security offices take applications and supply information about the program. Benefits include physicians’ services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A. Physicians transmit their insurance claims to fiscal agents/intermediaries for payment. Ten regional offices provide CMS with a decentralized administration and delivery of Medicare programs. Each regional office oversees private insurance companies that contract with the government to process and pay for Medicare Part B benefits. Also referred to as supplementary medical insurance (SMI) .

Managed care organizations (MCOs) are able to use their adjusted excess to reduce the Medicare Part B premium for beneficiaries. When offering this benefit, a plan cannot reduce its payment by more than 125% of the Medicare Part B premium. In order to calculate the Part B premium reduction amount, the PBP system must multiply the number entered in the “indicate your MCO plan payment reduction amount, per member” field by 80%. The resulting number is the Part B premium reduction amount for each member in that particular plan rounded to the nearest multiple of 10 cents.