Medicare vs Medicare Advantage
According to the Centers for Medicare and Medicaid Services, CMS, Medicare Advantage, also known as the Medicare Part C Program, officially launched in 2003. Although it launched in 2003, it is still creating a frenzy in many doctor offices today. The reason is because many offices do not know the difference between traditional Medicare and Medicare Advantage and neither do the patients.
When a patient walks in to an office with a Medicare card, often times the front desk will automatically assume the patient has “straight” Medicare when in actuality unless you call to verify this with Medicare, the patient can either have Medicare or Medicare Advantage. This is why even verifying Medicare benefits is important.
One of the major differences between Medicare and Medicare Advantage is that Medicare is administered by the federal government and Medicare Advantage is administered by private insurance companies. This is a big deal because if a patient has a Medicare Advantage plan they are not only offered the same coverage as Medicare, but they may also have additional benefits that may be covered that may not be covered under Medicare.
Another difference is that some Medicare Advantage plans set their own rules and guidelines for their members to follow such as using certain providers and/or co-pays and other out of pocket expenses. Once this out of pocket expense is reached, the patient’s insurance pays out at 100% of their allowed amount. The limit for a patient’s out of pocket maximum can vary from plan to plan and can change each year. Medicare does not have an annual cap for a patient’s out of pocket costs and the government determines what the patient’s premium will be.
If your practice is struggling with knowing when a patient has Medicare or a Medicare Advantage plan, contact us today at 540.300.3736 or by completing this form and we will be glad to help you come up with effective solutions to tackle your Medicare verification issues.