Medicare Advantage

Medicare Advantage plans are also known as Medicare Part C.

♦ A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.

Medicare Advantage Plans include:

• Health Maintenance Organizations

• Preferred Provider Organizations

• Private Fee-for-Service Plans

• Special Needs Plans

• Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.

♦ Most Medicare Advantage Plans plans are paid enough by the government to offer very low – sometimes even $0 premium plans – in addition to extra benefits that go above and beyond what Medicare regularly covers.

For example, you might get some dental, vision, and fitness benefits.

Medical Advantage plans are given a fixed prepayment per patient, as opposed to traditional Medicare, which uses a pay-for-service reimbursement model.

The belief was that this system would incentivize Medicare Advantage plans to provide services efficiently and to provide better preventative care upfront to save costs and keep people out of hospitals.

In actual practice there have been many complaints about rationing of care and improper denial of service in favor of profits.

Cornell University found that Medicare Advantage plans have made money by cutting the number of days of post-acute care following surgery compared to traditional Medicare.

They also found that patients are more likely to be sent to less expensive home health agencies with a star rating of one or two, and less likely to be sent to one with a four or five rating.

While there are many good things related to well run Advantage plans, there is also the strong temptation to withhold services and even upcode claims to boost profits.

Federal oversight is under-resourced, and the Centers for Medicare and Medicaid Services does not prosecute upcoding as fraud.