![]() Since a client has a yearly option to choose original Medicare or a Medicare Advantage plan, medical care for the injuries may have been provided through both programs.Ĭaution: Many clients who qualify for Medicare may mistakenly say they are on Medicare, when in fact they are receiving health care through an MAO plan. A Part D provider may also issue an identification card for the beneficiary to obtain prescription drugs.īoth original Medicare and a Medicare Advantage plan have lien claim rights for medical services provided to a Medicare beneficiary for injuries sustained through the fault of a third party. They can only use the MAO identification card for the healthcare coverage provided by the MAO. Unless there is an overlap in coverage periods, Medicare beneficiaries who are enrolled in an MAO plan cannot use the red, white and blue card for their health care. The MAO card may or may not say it is a Medicare Advantage healthcare provider, but it most likely will explain the basics of the MAO plan. The red, white and blue Medicare identification card and an identification card issued by the MAO. Persons who opt for a Medicare Advantage healthcare plan will have two cards. Healthcare that is provided under the red, white and blue card is known as “original” (or “traditional”) Medicare. The balance of this compendium concerns an MAO’s right to reimbursement for benefits provided to a tortiously injured beneficiary.Īll persons who qualify for Medicare receive a Medicare identification card that is red, white and blue. § 1395w-102(4), “Application of Secondary Payor Provisions”.) Therefore, it is imperative for a tortiously injured beneficiary who received Part D prescription drugs to notify the Part D plan administrator of a claim against a third-party tortfeasor. Under the Medicare Act, the Part D plan provider has the same lien claim reimbursement rights as an MAO has under a Medicare Advantage plan. There is a formulary for payment of the prescription drugs between the beneficiary and the Part D provider. The beneficiary pays a small monthly premium. Most Medicare Advantage plans include Part D drug coverage. The private company administers the Part D plan. The prescription drugs are provided to the Medicare beneficiary by a private company. Under Part D, a Medicare beneficiary can annually sign-up for prescription drug benefits. Medicare Part D, prescription drug benefit At this writing, nearly 40% of Medicare beneficiaries have healthcare benefits under a Medicare Advantage plan. ![]() Most MAO plans provide additional benefits, such as prescription drugs. The MAO provides all original Medicare Part A and Part B healthcare. The Medicare Advantage private insurance carrier is known as a Medicare Advantage Organization (MAO). § 1395w -21 to -29) and funded by CMS, usually on a capitated basis. This elected healthcare plan is known as “Medicare Advantage.” Medicare Advantage is governed by the Medicare Act (42 U.S.C. The Medicare Act allows a Medicare beneficiary to select a private insurance carrier to provide healthcare coverage instead of healthcare obtained through original Medicare. The supplemental insurance, inter alia, pays the 20% Part B costs and some of the hospitalization expenses not covered by Part A. Private insurance coverage, known as “supplemental” insurance, is available for purchase by the beneficiary. Under Part B, original Medicare pays a healthcare provider 80% of the provider’s fee, and the beneficiary is required to pay the 20% balance. Typically, original Medicare pays for a limited number of hospital days and other services under Part A. ![]() The Medicare beneficiary can choose any healthcare provider that honors original Medicare coverage. Original Medicare is a fee-for-service program. Medicare Part A, for hospitalization, and Part B, for medical doctors and healthcare services, are known as original ( aka traditional) Medicare. ![]() (The other parts of the Medicare Act are not discussed in this compendium.) The four parts are: The Medicare Act has four primary parts that allow for Medicare healthcare. § 1395w -21 to -29) This article concerns lien rights under a Medicare Advantage program. § 1395 et seq.) The Medicare Act provides an option that allows Medicare beneficiaries to have their Medicare healthcare coverage administered through private insurance companies, under a program called “Medicare Advantage.” (42 U.S.C. The Medicare program is controlled by the Medicare Act. Generally, Medicare coverage is for individuals who qualify for Social Security benefits. It is administered by the Centers for Medicare and Medicaid Services (CMS). Medicare is a healthcare program for Social Security beneficiaries. ![]()
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