Monday, June 22, 2009
Sunday, June 7, 2009
Medicare vs. Medicare Advantage
It seems daily people are confused as to what insurance they really have. The first thing individuals should do is review their policy if they do not understand the coverage call the 800 number on the back of the insurance card. Never automatically assume that you have medicare just because you have a medicare card ! It is common to have medicare and then a medicare advantage policy for insurance coverage.
Medicare advantage plans are extremly popular these days. Most of the older population have medicare or medicare advantage. These two names are NOT the same. For example, most private insurance companies have their own medicare advantage plan. What does that mean? Medicare (the government) has said that they will allow for private insurance companies to offer coverage to seniors who would normally have traditional medicare. This allows for private insurance companies to bill premiums,collect copays or deductibles and then they pay the claims submitted. Obviously, this benefits everyone. People are given other choices than Medicare and it allows private insurance to "compete" in this market.
If someone has a medicare advantage plan that means the insurance company that provides that policy is who collects the premium and pays the claims. Lets use BCBSM as an example. If someone has Medicare plus blue the person pays BCBSM for the policy and they in return pay the claim. Now to confuse things more most of these claims are billed to a contracted area of BCBSM not to BCBSM directly. The provider that is supplying the service or product should call the provider number on the back of the card to find out where the claim should be sent. In the case of BCBSM most of the medicare advantage claims go to Dmension Benefit. In addition, these claims are paper submitted unlike Medicare claims which are all sent electronic.
Medicare and medicare advantage plans cover similar services but not always the exact services. The policies do vary in coverage and premium price. Medicare only covers 80% of services. Most people have secondary insurance plans that they pay to cover the 20% leftover.
Medicare advantage plans typically pay 90% of services.
For questions regarding either of these insurances please contact www.medicare.gov or www.bcbsm.com. In addition you can contact www.oxygenplusmichigan.com if you have specific questions on home medical euquipment that may be needed.
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