The Great and (Simultaneously) Terrible Medicare, Part V - Medicare Part C Advantage Plans


Alrighty! For better or worse, this is not only the last Medicare article we'll have in our series, but it's also the last article altogether in our ongoing series on liens and subrogation. Congrats, you made it!

Medicare Part C - Advantage Plans

This article deals with Medicare Part C, or what are more commonly known as "Medicare Advantage Plans." We've already talked about Medicare Parts A and B, which function as the more traditional federal Medicare benefits that we all know and love. We've also briefly discussed Medicare Part D, which is a relatively recent form of coverage contemplating prescriptions. Medicare Part C (again, what we'll call "Advantage Plans") looks more like private insurance. As a matter of fact, Advantage Plans are provided by private providers like Blue Cross Blue Shield, SecureHorizons, Humana, and Coventry, which are then subsidized by the Program itself.

What's the big Advantage, then?

So Medicare Part A and B doesn't include additional forms of coverage like vision, dental, hearing, et cetera. A lot of Advantage plans do include some of those extras, and some even include Part D prescription coverage.

Do Advantage Plans still get the regular Medicare right of reimbursement?

Most likely. The same federal law that gives regular Medicare its right of reimbursement is generally accepted to apply to Part C as well. This hasn't been tested quite yet in North Carolina, but most jurisdictions that have addressed it have come down on the side of the Plan.

So what should I do?

First you need to get a copy of the policy and pinpoint the provision that gives the Plan the right to reimbursement. You'll need to audit the expenses that the Plan is claiming just like you normally would. Remember that the policy is essentially just a contract; if there isn't a provision to the contrary, the Plan will be bound by the same procurement cost reduction that we talked about last week.

Thanks guys! Catch you next time!