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State Licensure Requirements for Medicare Advantage Plan

Discuss state licensure requirements that an organization must comply with in order to become a Medicare Advantage Plan, any exceptions to the State licensure requirement, and any cases in which special consideration is given to particular types of entities. Include two APA citations.

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Medicare Licensure

State licensure requirements that organizations must comply with in order to become a part of the Medicare Advantage Plan is first it must be licensed under state law, or authorized to operate under State law, as a risk-bearing entity that is eligible to offer health insurance or health benefits coverage (Medicare A and B, and parts of D) in each State by which it offers one or more Medicare Advantage plan ("Electronic Codes of Federal Regulations", 2011). However, according to Zarabozo and Lindenberg (2007) an entity does not need to be formally licensed by the state regulatory body overseeing HMOs and health insurers just as long as the organization legal status and financial status is able to manage the risk entailed by the Medicare contract. For example, an organization operating as a Medicaid HMO that was ...

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The solution discusses the state licensure requirements for medicare advantage plan.