Medicare+Choice Private Fee-for-Service Plan Law and Legal Definition

A medicare+choice private fee-for-service plan is a type of medicare advantage plan offered by a private insurance company that reimburses hospitals, physicians, and other service providers, at a rate determined by the plan on a fee-for-service basis without placing the provider at financial risk. Medicare offers health care coverage to the beneficiaries of such plan by paying a set amount of money to the private insurance company. Medicare makes such payments on a monthly basis.

According to 42 USCS § 1395w-28 (b) (2) the term "Medicare + Choice private fee-for-service plan" means a Medicare + Choice plan that:

(A) reimburses hospitals, physicians, and other providers at a rate determined by the plan on a fee-for-service basis without placing the provider at financial risk;

(B) does not vary such rates for such a provider based on utilization relating to such provider; and

(C) does not restrict the selection of providers among those who are lawfully authorized to provide the covered services and agree to accept the terms and conditions of payment established by the plan.