Medicare Advantage Plan

Medicare Advantage Plan is a program introduced to cover all Medicare services that were covered by Original Medicare except hospice care. However, even if the client is in original Medicare Advantage Plan, Original Medicare can still cover for the hospice care. All types of Medicare Advantage Plans covers any urgently needed care and emergency care.

However, a plan can choose not to cover the services that are not medically necessary under Medicare. The clients are therefore advised to check with their provider to know whether an individual service is covered. Medicare Advantage plan may also offer extra coverage such as hearing, vision, and dental or wellness programs.

If a client is need of a service that is not medically necessary, they are required to cover the costs of services or appeal such decisions. It is also possible to ask the plan for a written advance coverage decision to ensure that a service is medically necessary and therefore will be covered. Whenever a plan fails to pay for a service that a client needs, then they will have to cover all the costs if a customer did not confirm in advance of the coverage decision.

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Differences between Original Medicare and Medicare Advantage Plan

– The traditional Medicare program was mainly administered by the federal government while the new Medicare Advantage Plan is offered through commercial partners such as insurance companies.

– Original Medicare includes both Part A and B (hospital and Medical) coverage if you enroll in both but the new Medicare plan covers some extra benefits such as dental care and vision.

– In traditional Medicare, you pay a coinsurance whenever you receive medical services while but in Medicare Advantage Plan you pay a deductible copay fixed fee per office visit.

– In Original Medicare, you can go to any hospital or doctor in the country who accepts Medicare but in Medicare Advantage Plan you are required to use hospitals under the plan’s network.

– There are no prior authorization or referrals needed to see a specialist in Original Medicare but in modern Medicare you may have to get referrals to see a specialist, choose Primary Care Physician and get prior authorization for certain services.

– In Original Medicare, you can buy a Medigap plan as supplemental coverage but in modern Medicare, it is not possible to buy Medigap supplemental insurance to assist in paying your out-of-pocket costs.

Visit Connect for more information about InnovaCare Health.

Medicare Advantage Plan is provided through insurance companies, and one of the leading firms is InnovaCare Health headquartered in Fort Lee, New Jersey. The company is headed by Rick Shinto, M.D., MBA & President and Chief Executive Officer of InnovaCare, & Penelope Kokkinides, Chief Administrative Officer and being one of the largest providers of healthcare in the United States coordinates more than 270000 commercial members and 275000 Medicare beneficiaries through innovative models.

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According to Chief Operating Officer Penelope Kokkinides, the company mainly improves care through Medicare Advantage Plan and healthcare network models. Medicare Advantage plans offered by InnovaCare are MMM Healthcare and PMC Medicare Choice. MMC/PMC covers healthcare benefits to nearly 218,000 beneficiaries ranging from specialist to community centers. InnovaCare Health also builds provider networks, Patient-Centered Medical Homes, ACOs and healthcare models involving global risks and managed care.

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