Medicare Advantage
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MEDICARE ADVANTAGE
Medicare Advantage (Part C) (MA)is a health insurance program of managed health care (PPO or HMO) that serves as a substitute for “Original Medicare” Parts A and B Medicare benefits. Medicare Part A provides payments for in-patient hospital services excluding those of physicians and surgeons. Part B provides payments to physicians and surgeons, as well as for medically necessary outpatient hospital services (such as ER, laboratory, x-rays and diagnostic tests) and certain durable medical equipment and supplies. Original Medicare claims payments are processed through the Centers for Medicare and Medicaid Services (“CMS”). In contrast, Medicare Advantage is offered by commercial insurance companies and HMO and PPO corporations, who receive compensation from the federal government, but do not process claims through the CMS.
Most Medicare Advantage plans (sometimes referred to a “Part C”) include the Part D prescription drug benefit plan, and are known as a Medicare Advantage Prescription Drug plan or “MAPD.”
Medicare Advantage originated with the passage of the Balanced Budget Act of 1997, which offered Medicare beneficiaries this option, instead of receiving these benefits through the original Medicare plan (Parts A and B). These programs were first known as Medicare+Choice or Part C plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices changed for insurers that offer these plans, and “Medicare+Choice” plans became known as Medicare Advantage plans.
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