Medicare is a significant source of income for most hospitals and healthcare facilities in the United States. However, sometimes the terms used may need to be clarified. In this article, we will explore what Medicare Advantage Plans are, what facilities need to know about Medicare Advantage, and what the differences are between Medicare Advantage and Original Medicare.
What are Medicare Advantage Plans?
Private companies that contract with Medicare offer Medicare Advantage (M.A.) plans (also known as "Medicare Part C"). An alternative option to Original Medicare, Medicare Advantage plans may cover extra benefits. These additional benefits are Part A, Part B, and usually, Part D. Medicare Advantage plans are another way to receive Medicare Part A and Part B coverage. A Medicare Advantage Plan, sometimes called a "Part C" or "M.A. Plan," is offered by a private company approved by Medicare and subject to its rules. In a Medicare Advantage Plan, you'll still have Medicare, but your Medicare Advantage Plan will cover most Part A & Part B benefits. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D). The MA plans appeal to consumers because they bundle services with annual limits on out-of-pocket expenses. Extra benefits may include transportation services, meal delivery services, fitness programs, and even tailor-made treatment plans for specific illnesses. One significant benefit of joining a M.A. plan is that even if you have a pre-existing condition, you can still join. Open enrollment is between October 15th and December 7th. You can make changes, drop, or change M.A. plans between January and March. If you need an insurance plan, you can learn more about the healthcare marketplace by reading our previous blog post here. There are many different kinds of M.A. plans, including:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs plans (SNPs)
- Medical Savings Account (MSA) plans
What Your Facility Needs to Know About Medicare Advantage
These plans last only one year, and facilities must decide which M.A. plans to accept, change, or eliminate each year. According to Forbes magazine, the top six providers in 2023 are:
- Humana
- Blue Cross / Blue Shield
- Anthem
- United Healthcare
- Cigna
- Aetna
MA plans' drug coverage is one of the most critical items that change yearly. Therefore, facilities need to employ Registered Nurses (RNs), certified nurse assistants (CNAs), licensed nurse practitioners (LPNs), allied health workers, and many various staffing positions to provide patient care and keep up with changes. Nursa helps facilities fill those shifts and find local PRN nursing staff and allied health workers using the Nursa app for mobile devices.
Facilities need to be aware that referrals are often not required under Original Medicare. However, with the M.A. plan, participants may have to get prior approval for most procedures and medications. Skilled nursing news has this to say about new customers and how to use M.A. plans on where to place mom and dad at various nursing homes within the M.A. plans:
"We're certainly a magnet for new customers. We're using this as a major selling point, as families are considering where to place their mom or dad. The natural place that we're most likely to direct people is either to our buildings or that of our partners."
What's The Difference Between Medicare Advantage and Medicare?
Part A (Hospital Insurance) and Part B (Medical Insurance) are parts of Original Medicare, a fee-for-service health plan. You pay your share (coinsurance and deductibles) after Medicare pays its share of the pre-approved amount. Plans may offer extra benefits that Original Medicare doesn't provide, like vision, hearing and dental services. Additionally, you can join a different Medicare drug plan if you want drug coverage through Medicare (Part D).
One of the significant differences between Original Medicare and M.A. plans is that you can see any doctor in the U.S. with Original Medicare. In contrast, M.A. plans, where you can only see doctors within a limited network. Medicare lets everyone compare prices and M.A. plans on their website here. Medigap cannot be purchased or used when on an M.A. plan. As an alternative to Original Medicare, Medigap can be bought to help offset out-of-pocket expenses, such as coinsurance payments, and to access coverage from a former employer or union.
Regarding foreign travel, Original Medicare does not cover medical services outside the U.S. However, Medigap can be used as a supplement to providing emergency services. M.A. plans generally do not cover foreign medical services, but supplemental plans can offer special emergency services for foreign travel needs.
Nursa Helps Facilities with Staffing Solutions
Nursa is a staffing solution application for facilities. Nursa is an easy, cost-effective solution to assist facilities with staffing shortages for PRN or per diem assignments. Nursa offers facilities a half-hour introduction to the application, instructions on how to use the system, and assistance with scheduling the first shift of staffing. Nursa focuses on helping facilities understand their staffing problems and how to solve them. After the demonstration, a facility can fully manage the Nursa application, which will enable it to address staffing shortages. Nursa saves time and money and adds quality solutions to facility staffing shortages. Nursa can help various facilities, like hospitals, nursing homes, long-term care facilities, and many others.
