Medicare Advantage Plans
Frequently Asked Questions III
Medicare Advantage Plans (Medicare Part C) are optional Medicare plans offered by Medicare-approved private companies and available to people already enrolled in both Medicare Part A (hospital) and Medicare Part B (medical).
Medicare Advantage plans can provide additional coverage in various areas of health including dental, vision, and hearing, and most plans also include prescription drug coverage. Following are some frequently asked questions and answers about Medicare Advantage plans.
Why have some Medicare managed care plans increased their premiums and/or reduced their benefits?
Although all Medicare managed care plans (Medicare Advantage plans) must offer the basic Medicare benefits, plans are permitted by law to choose which extra benefits to offer. Companies offering Medicare managed plans can also set premium and co-payment amounts according to their own practices.
As long as basic benefits are offered and premiums and cost-sharing amounts are within legal limits, companies are allowed to make adjustments to plans they offer.
Is it appropriate that my provider is being asked to refund a payment?
There may be cases where claims systems have not been updated to reflect disenrollment from Medicare Advantage (MA) plans. If a claim was mistakenly paid for someone formerly enrolled in a MA plan who was disenrolled at the time medical services were rendered, the provider may be contacted so that any overpayment can be recovered. If your provider receives an overpayment letter, you can expect to be contacted in order to provide further information.
If you have further questions about this process, contact 1-800-MEDICARE (1-800-633-4227) and select the “billing” option. TTY users should call 1-877-486-2048.
What should I do if my plan says it won’t provide or pay for an item or service that I think should be covered?
If your Medicare Advantage plan decides it will not cover or pay for a service you believe should be covered, your plan must explain this decision in writing. Carefully read the decision letter and your plan’s policy. If you still believe the service or item should be covered, you can follow appeal procedures outlined in the decision letter.
If you have further questions about Medicare Advantage or any other aspect of Medicare, contact MedicareMall now and let us lead you with confidence through the Medicare maze!