Medicare Advantage (MA) Plans
MA plans are also known as Medicare Part C, Medicare+Choice or Health Maintenance Organizations (HMOs). There are several types of MA plans, and each of these plans replaces “traditional” Medicare benefits. MA plans provide Medicare-covered benefits to members through the plan and may offer extra benefits that Medicare does not cover, such as vision or dental services. Members may have to pay an additional monthly premium for the extra benefits. The plan may have special rules that its members need to follow. Plan members generally get their Medicare-covered health care through that plan. Some plans also include Medicare prescription drug coverage. Benefits may be different from those in “traditional” Medicare and, since each plan can vary, it is very important that people review the plan materials for details about copayment and coverage information.
Providers can verify Medicare eligibility for patients who have enrolled in an MA plan by calling the IVR system or by using the online inquiry system. Notification that the patient has joined a plan, the effective dates and the identification number of that specific plan will be released.
CMS has published a plan directory that provides further information regarding an MA plan. The plan directory, listing all MA plans and the identification numbers, is on the CMS Web site at:
http://www.cms.gov/MCRAdvPartDEnrolData/MACPC/list.asp#TopOfPage
Questions that might be asked during patient screening include:
Have you made any recent changes to your Medicare plan?
Have you recently added or updated your Medicare Part D (prescription drug) portion of your Medicare benefits?
Have you received a new Medicare health insurance card for this year?
It is important to remember that people who join an MA plan:
Are still in the Medicare program.
Still have Medicare rights and protections.
Will have a member ID card issued by the MA plan that should be used in place of the “traditional” Medicare red, white and blue card.
Will still get all their regular Medicare-covered services that are offered under Part A and Part B through the MA plan.
May get additional benefits offered through the plan, including Medicare prescription drug coverage. Other extra benefits could include coverage for vision, hearing, or dental care and/or health and wellness programs. Extent or duration of coverage may vary.