How does out of network coverage work with Medicare Advantage?

[somarco]

Even on the hospital website it says it doesnt accept all medicare supplement plans let alone the MAPDs. Which is surprising because I was told if medicare pays, supplements will pay, but apparently this isnt the case.

The tail doesn't wag the dog . . .

 

[jack3454]

They only need to accept Medicare. The hospital will not bill the insurance company.

Ok what does this mean then?

Medicare Supplemental (MediGap) policies allow enrollees to see any provider that accepts Medicare. Some of these supplemental plans are accepted at MD Anderson. However, we do not accept any supplemental plans that require enrollees to use a provider in a restricted network that does not include MD Anderson or its physicians.

 

[LostDollar]

Not really. It just appears that way. What @Chazm says is correct.

As I said before, there are some exceptions to Chazm's statement.

If we are talking about Hospitals as Part B providers for a Medicare Beneficiary using Original Medicare and a Medigap plan, Chazm's statement is not correct for all situations.

 

[rmhaire]

As I said before, there are some exceptions to Chazm's statement.

If we are talking about Hospitals as Part B providers for a Medicare Beneficiary using Original Medicare and a Medigap plan, Chazm's statement is not correct for all situations.

How about some examples of what you're talking about. Still not sure what you mean.

 

[LostDollar]

Providers used to bill supplement carriers but that was back in the stone age. Today Medicare knows everything there is to know about you and your Medicare supplement. It's even listed on your account with Medicare.gov.

At least in Kansas, this does not mean the Medicare MAC will send the Part B Hospital provider bill on to the Medigap carrier.

The Hospital has to send their bill to the Medigap carrier as well as Medicare.

 

[Chazm]

Ok what does this mean then?

Medicare Supplemental (MediGap) policies allow enrollees to see any provider that accepts Medicare. Some of these supplemental plans are accepted at MD Anderson. However, we do not accept any supplemental plans that require enrollees to use a provider in a restricted network that does not include MD Anderson or its physicians.

They are most likely referring to Select Plans. I’ve never sold one but they have a hospital network.

 

[Chazm]

As I said before, there are some exceptions to Chazm's statement.

If we are talking about Hospitals as Part B providers for a Medicare Beneficiary using Original Medicare and a Medigap plan, Chazm's statement is not correct for all situations.

It’s correct for all situations for clients with a non select Medigap plan. If the facility or doctor accepts medicare, you have complete access.

Look at any ID card from MOO or Aetna. The back of the card says, PROVIDERS - do not send claims to us, they will be rejected.

 

[rmhaire]

They are most likely referring to Select Plans. I’ve never sold one but they have a hospital network.

I was going to suggest that but you beat me to it.

Just curious though. Do you still see those in FL? I haven't seen one in years.

 

[rmhaire]

At least in Kansas, this does not mean the Medicare MAC will send the Part B Hospital provider bill on to the Medigap carrier.

The Hospital has to send their bill to the Medigap carrier as well as Medicare.

Could be something that's state specific. I don't do Kansas so I wouldn't know.

All I know about Kansas is that Dorothy and Toto left.

 

[Chazm]

I was going to suggest that but you beat me to it.

Just curious though. Do you still see those in FL? I haven't seen one in years.

Yes, FL Blue and UHC definitely have them.