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Medicare: Advantage Plans




Medicare Advantage plans 101


What is the difference between Traditional Medicare and Medicare Advantage (MA) plans? 

Medicare Advantage (MA) plans are private health insurance plans that provide Medicare Part A and B benefits, often additional benefits like prescription drug coverage and dental care. MA plans are offered by private insurance companies that contract with Medicare.


How does being PAR or Non-PAR affect Medicare Advantage Plans?


PAR Medicare Advantage plans contract with a network of healthcare providers who have agreed to accept Medicare's allowable charges as payment in full for all their Medicare Advantage patients. The patient will only be responsible for their deductible and co-insurance, and the Medicare Advantage plan will pay the rest. Unlike Traditional PAR Medicare, PAR Medicare Advantage plans are not required to see (accept assignment) for all Medicare Advantage patients. 


Non-PAR Medicare Advantage plans contract with a network of healthcare providers who may charge more than Medicare's allowable charges. Patients who see a non-PAR provider may be responsible for paying the difference between the provider's charge and the Medicare Advantage plan's allowable charge.


If you choose Non-PAR with Traditional Medicare, can you enroll in Medicare Advantage plans? 

Yes, you can have a Medicare Advantage plan even if you are not participating in Medicare. However, there are some things to keep in mind.


- Non-PAR Medicare Advantage plans are not allowed to balance bill patients. This means a provider cannot charge patients more than the Medicare Advantage plan's allowable charge.

- Only a limited number of Medicare Advantage plans accept non-participating providers. 

- Patients may have to pay more for their Medicare Advantage plan if they are on a non-participating plan. This is because the MA plan will have to pay more for the patient's care since they cannot negotiate lower rates with non-participating providers.

- Patients may have to pay more for out-of-pocket costs if they use non-participating providers. This is because Medicare Advantage plans typically have lower out-of-pocket costs for services provided by in-network providers.


Feature

PAR Medicare Advantage plan

Non-PAR Medicare Advantage plan

Contracts with a network of healthcare providers who have agreed to accept Medicare's allowable charges as payment in full

Yes

No. May contract with a network of healthcare providers who may charge more than Medicare's allowable charges

Patient pays deductible and co-insurance only

Yes

No. Patient may be responsible for paying the difference between the provider's charge and the Medicare Advantage plan's allowable charge

Considering the pros and cons of joining a Medicare Advantage plan is essential if you are not participating in Medicare. You'll be limited in the plans you can enroll with as a non-PAR provider. And if those plans are open to providers when you try to enroll, you avoid being unable to enroll with any non-PAR plan.

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