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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

Does this primary care bonus apply to my patients covered by a Medicare Advantage (MA) plan?

The bonus is primarily focused on services to beneficiaries within traditional Fee-for-Service Medicare. The primary care bonus must be paid by an MA plan only under the circumstance when the plan pays an eligible physician on a non-contractual basis. CMS is still working with the MA plans on a methodology to deliver such payments. The bonus payment does not apply with respect to physicians that contract with MA plans, since contracted physicians have the flexibility to negotiate their payment rates with the MA plans they elect to join.

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