What You, a Healthcare Provider, Needs to Know About Advantage Medicare
At age 65, American adults are eligible to enroll in Medicare, a senior-focused federal health insurance program that covers hospital services, medical services, and prescription drugs. They can also choose a Medicare Advantage plan (also known as Part C of the program) offered by private insurers. These plans generally charge lower monthly premiums than traditional Medicare plans or offer low or no premium at all and provide additional benefits.
Healthcare providers need to know what Medicare Advantage does and does not cover as well as how it differs from Original Medicare.
What Is Medicare Advantage and What Does It Cover?
KelseyCare Advantage shows that Medicare Advantage can include vision benefits, dental benefits, and even access to senior-focused fitness programs. Benefits covered by Medicare Advantage will differ from provider to provider.
How Are Healthcare Providers Reimbursed by Medicare Advantage?
As previously stated, Medicare Advantage plans frequently charge $0 monthly premiums. So, how do they compensate their service providers?
When companies offer Medicare Advantage plans, they receive a set amount of money from the federal government. This money is enough to cover Parts A and B of Medicare. However, most companies try to save this money by sticking to a limited provider network. As such, they only have to compensate a select number of healthcare providers. By doing so, they are able to roll their savings into their patients.
Furthermore, even though Medicare Advantage plans do not charge monthly premiums, patients must still pay out-of-pocket expenses. Providers are then compensated through the company’s Medicare-provided allowance as well as the deductibles, coinsurances, and copayments paid by patients.
What Impact Do Networks Have on Healthcare Providers?
Patients enrolled in Medicare Advantage have the option of selecting between Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) (PPO). Patients who choose HMOs pay lower monthly premiums, but their provider network is limited. Patients who choose PPOs, on the other hand, can use any provider but pay less to see in-network providers.
As The Behavioral Healthcare Executive demonstrates, being a part of a provider network can provide numerous advantages to both payers and providers. For one thing, because of the cost differences, member patients will be more likely to seek services from providers in their network. This could result in more patients visiting a provider’s office. Furthermore, because being a part of a network is also a long-term relationship between healthcare providers and payers, healthcare providers no longer need to rely on self-pay, which forces them to do a lot of their own advertising. Payers are doing their marketing for in-network providers.
What Kind of Medicare Advantage Do Patients Prefer?
For many patients, Medicare Advantage is an appealing option. By 2017, one-third of Medicare-eligible adults were registered in a Medicare plan. Enrollment in Medicare Advantage is expected to increase to 41% by 2027. And though Medicare remains the most popular option, Medicare Advantage has become a viable option for many due to its affordability and increased benefits.
Medicare Advantage Situation During the Pandemic
To reduce safety risks during the pandemic, the Centers for Medicare and Medicaid Services announced in 2020 that it would waive or reduce cost-sharing fees for telehealth services. As a result, many Medicare Advantage plans included telemedicine benefits. In addition, long-term care coverage was expanded in 2021, including in-home personal care programmes, adult day programmes, and meal delivery services.
Medicare Advantage is a type of health insurance plan offered by private insurers to seniors. By being strategic with federal allowances, Medicare Advantage can offer more benefits at a lower cost, attracting more enrollees and providing a consistent stream of income to partner providers.
