Medicare Advantage Plan and physicians service practice
Medicare Advantage plans
Medicare Advantage plan is medical insurance plan which advanced from the original American Medicare , which is in two parts. Part A, where Medicare, provides for payments for inpatient hospital bills other than the physicians and surgeon bills and Part B, for both surgeon and physician bills in addition to the outpatient hospital charges and some medical equipment and supplies with long life span according to Rick Shinto. However, in the case of Medicare Advantage Plan scheme, individuals enter into an agreement with government through either the Preferred Provider Organizations (PPOs) or Health maintenance organization (HMOs) and get predetermined sums payment per capita to cater for their Medicare benefits which are wider than the original plan. The benefits include all part A and part B benefits and an additional part D plan commonly referred to as Medicare Advantage Prescription Drug Plan (MAPD) that provides for drug prescription. Further advantage still, the Medicare Advantage plan has is, the individual claims payment get processed by commercial insurance firms who after processing the application, get subsidies from the government.
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In spite of the fact that under Medicare Advantage Plan the coverage is widened, the plan has not to pay for excess $6,700, which is the limit for out-of-pocket cost per year for part A and part B benefits. However, once the out-of-pocket limit is reached by the individual, the plan provides for 100% of hospital services for the remaining period in of the year according to Penelope Kokkinides. These commercial insurance firms providing for Medicare Advantage plan are in three types; Health Maintenance Organizations (HMOs), Private Fee-For-Service (PFFS), and Preferred Provider Organizations (PPOs). The advantage of using the three Medicare types is that they provide for more hospital services which include Part A, part B and Part D, which provides for prescription drug benefits. It is because of these advantages that the Medicare Advantage Plan in InnovaCare Health has had an increase in the enrollment. In the recent 2005, the enrollment stood at 5.4 million but in 2014 the enrollment grew to 15.7 million (CMS, 2014)
Physicians’ services practice
In InnovaCare Health, the physician’s services practice requires that persons who have Medicare Advantage plan enrolled with Health Maintenance Organization should not be allowed to use some specialist physicians or even get medical services out –of- network providers without permission from the Health maintenance organization unless it is emergency. This restriction makes the patients who need a special attention to face payment challenges. To cater for such cases, however, The Medicare Advantage Plan has put in place The Preferred Provider Organization, which allows enrollees to access any physician or health facilities even without having permission from the organization.
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^ CMS (April 7, 2014). “Announcement of Calendar Year (CY) Twenty Fifteen Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter” (PDF). cms.gov. Retrieved 11 March 2015.
• ^ Medicare: Medicare Advantage – Kaiser Family Foundation
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