How to Use Medicare Advantage

To supplement their Medicare benefits, qualified seniors often purchase additional coverage through private insurers. In an attempt to reduce paperwork that results from filing separate claims through separate insurers, Medicare launched its Advantage plan, formerly known as Medicare+Choice or Medicare Part C. With Medicare Advantage, a patient receives all her care benefits through a private insurer who, in turn, receives payment from Medicare

Difficulty: Moderate

Instructions

1. A Medicare Advantage plan combines the benefits of traditional Medicare coverage with a supplemental policy, making it easier for medical clinics and health care providers to file claims. Most Medicare Advantage plans participate with a Health Maintenance Organization (HMO) plan and a majority of physicians now participate in an HMO.

2. To qualify for participation in the Medicare Advantage plan, private insurers must contract with HMO’s that provide a full range of patient care. Patients see their primary care physician and, if a specialist is warranted, the physician will make a request through the private insurance agency. HMO’s must also provide all health care services covered under Medicare Part A and Medicare Part B, which include hospitalization coverage and medical coverage, in order to participate in Medicare Advantage.

3. For a patient insured under the Medicare Advantage Plan, the private insurer will issue an insurance card and that is all the patient needs to present at the time they receive medical services. This card is also good for any prescription plans offered by the insurance agency. The health provider will bill the private insurer directly. In return, the insurer will receive fixed rate benefit from Medicare, no matter what the HMO charges.

4. A reduction in paperwork and an increase in efficiency are the goals of the Medicare Advantage plan. Since all the patient’s billing goes to one agency, the healthcare provider is more likely to receive prompt reimbursement. As a result, more primary care physicians are accepting new patients who participate in the Medicare Advantage Plan.

5. Medicare recipients are entering into a contract with a private insurance agency, which will have its own supplemental payment policies. While the agency must supply the regular Medicare coverage, they are free to alter their supplemental plan. Compare the benefits and costs of more than one plan before you choose. (See Resources)

Resources

• Locate Medicare Advantage plans through the American Association of Retired Persons.
• Find a participating physician in your community.

[Tippy]

on 8/5/2009 It seems like we just get the hang of this and they change the rules. Thank you.