Big changes for Medicare advantage enrollment are continuing to rise with more benefits and plans. Medical billing companies are on the way to examine key benefits of Medicare advantage plans for this year. The key changes explains program updates on Covid-19 public health emergency and renders advise on the basics of navigating the medical billing and reimbursement concerns.

It’s for the first time; Medicare advantage has reached 40% of the total Medicare eligible population. At present, 25.4 million people have enrolled in Medicare advantage plan with a population of 62.4 million according to CMS. In 2020 Medicare enrollments reached to more than 22 million compared to previous years. 22 million is more than one out of three beneficiaries in Medicare.

To run a successful billing program, medical billing companies must know the growth trend and the future of Medicare advantage program.

What is Medicare Advantage?

  • Medicare advantage actually acts as an alternative to the traditional Medicare which is an all in one healthcare plan and is sold by private insurance companies.
  • The Centers for Medicare and Medicaid had made it clear that it’s goal is to transform current fee for service models to value based care.
  • Medicare Advantage plans have decided to provide at least the same level of coverage as original Medicare, but they might impose different rules, restrictions and costs.
  • From the year 2013 to 2019, Medicare advantage plans grew by 60% and fee for service Medicare population grew by 5%.
  • The progress has reached to the levels that it essentially creates an ideal place for the Medicare beneficiaries.
  • Enrollment costs are low and have more plans than the new and innovative benefits.
  • But the question is, what does this mean to healthcare providers and medical billing companies?

Most Crucial Takeaways For Medicare Advantage plans in 2021:

  • The Medicare advantage enrollment is expected to continue to rise to 26 million as projected.
  • The three major changes entering into Medicare advantage plans in 2021 are:

Expansion of Telehealth Services and Coverage:

The data reveals that about 92% of Medicare advantage plans are likely to offer additional telehealth benefits that reach 20.7 million beneficiaries. About 58% of plans offered telehealth benefits in 2020.

CMS has revealed to release the detail plans in order to reduce the cost for telehealth services.

Expanded long term care coverage:

For example, it counts, adult day programs, in-home personal care services, benefits for over-the-counter products, home safety modifications including grab bars for bathrooms, wheelchair ramps and stair rails, and meal delivery and transportation.

Extra coverage options for patients with end stage renal disease:

According to CMS, some states have significant number of patients with ESRD. Medicare advantage plans in those areas are expected to be underpaid and can also be forced to increase the consumer costs by reducing supplemental benefits, with limited services for the enrolled beneficiaries.

  • The medical billing companies should be ready to estimate the maximum out of pocket limit for Medicare advantage plans. It’s likely to touch $7550 for 2021.
  • By implementing a standard plan, the maximum deductible reaches to $445 in 2021 and a threshold for entering into coverage phase where expenditure on out of pocket decreased drastically and now is increasing to $6550.

How did Covid-19 affect Medicare Advantage Plans?

  • Covid-19 stimulus package involves, Corona-virus Aid, Relief, and Economic Security act including $100 million in new funds for healthcare organizations and medical billing companies.
  • The Centers for Medicare and Medicaid Services made $30 billion of CARE’s funds available to healthcare professionals based on total Medicare fee for service reimbursements that result in higher payments to hospitals in some states than in others.
  • Hospitals that has higher shares of Medicare advantage enrollee might also have lower FFS reimbursement overall.
  • This results in hospitals and medical billing companies to get lesser reimbursements only if the allocations of funds are considered to receive on behalf of Medicare advantage enrollees.
  • In response to Covid-19 emergency, most of the Medicare advantage insurance companies waived off the cost sharing requirements for the treatment. It means that Medicare advantage beneficiaries need not pay cost sharing if at all they are hospitalized due to Covid-19.
  • Medicare requires to cover the vaccine for Covid-19 under Part B with no cost sharing for traditional Medicare or Medicare Advantage plan beneficiaries, that’s based on a provision in the Corona-virus Aid, Relief and Economic Security Act.

How hospitals and medical billing companies prepare for Medicare advantage?

  • When Medicare advantage plans continues to revamp, the most successful healthcare providers and medical billing companies who understands revenue cycle management, gets Medicare reimbursements as well as Medicare advantage beneficiaries.
  • Medicare advantage plans may continue to offer new benefits. They include:
  1. Prescribed Drugs
  2. Dental care
  3. Vision care and
  4. Hearing care , hearing aids.
  • These additional benefits act like bonus to the consumers. Few plans may also include offers like memberships to gyms and wellness programs.
  • But these additional benefits should be approved by The Centers for Medicare and Medicaid Services before the plan is being included.
  • The new benefits include services like:
  1. Home delivered meals
  2. Air conditioners for patients with asthma
  3. Transportation to provider’s office

 Quality of Care can get better:

  • The Affordable Care Act places an incentive system for Medicare advantage plans. Back in 2012, plans which provide high quality care will like be sure to receive a bonus.
  • According to the law, bonus money must be reinvested in additional plan benefits.
  • In the following days, Medicare Advantage plan providers will definitely continue to adapt and improve the quality of the plans that they offer in order to meet these bonus requirements.
  • In addition to the bonus program, Medicare issues star ratings for all Medicare Advantage plans every year, and these can be a major point of emphasis for consumers.
  • Medicare also announces and offers special enrollment period for those who haven’t enrolled so far and wants to switch to one.
  • The continued emphasis on star ratings by Medicare Advantage consumers can help keep the plan quality in check for years to come.


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