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:
Prescribed Drugs
Dental care
Vision care and
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:
Home delivered meals
Air conditioners for patients with asthma
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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