How does out of network coverage work with Medicare Advantage?

[LostDollar]

It’s correct for all situations for clients with a non select Medigap plan.

Again, not true. I have an HDF Medigap plan. The Kansas Medicare MAC did NOT send any of my 2022 Part B Hospital provider claims to the Medigap carrier. The Hospitals had to bill the Medigap carrier as well as Medicare for their claims.

My 2022 Part B Hospital provider MEOB's were different from Non-hospital Part B provider MEOB's in two ways. This was one of them.

The other difference was that the Medicare Approved Amount column for all Medicare Approved services was 100 percent of the provider charge.

 

[LostDollar]

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.

The available Medigap plan listings I pick up at the extension office from time to time have shown some select plans available. This has been the case for the duration of my time on Medicare.

Carriers Blue Cross and UHC as Chazm suggests for FL.

When I talked with the SHIP counselor at the extension office when I first went on Medicare and was trying to decide MAPD vs Medigap and , if Medigap, what specific plan within the Medigap category, She specifically pointed out the Select Plans and made one or two positive comments about them. She did NOT say buy these, but as I recall she did make the point that local hospitals were in network with them.

 

[LostDollar]

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

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

I figured it was something to do with Part B provider type -- Hospital vs non-hospital, but I don't know.

Do your Georgia MEOB's for Hospital Part B services have the footnote showing the claim was automatically sent to your Medigap plan?

 

[rmhaire]

I figured it was something to do with Part B provider type -- Hospital vs non-hospital, but I don't know.

Do your Georgia MEOB's for Hospital Part B services have the footnote showing the claim was automatically sent to your Medigap plan?

None that I've seen.

Our EOBs are pretty much carrier specific. They come from the carrier after Medicare has paid.

 

[LostDollar]

None that I've seen.

Our EOBs are pretty much carrier specific. They come from the carrier after Medicare has paid.

Yes, my Bankers Fidelity EOBs are different than the ones from Medico were.

I was asking about the Medicare MEOB/MSN, not the carrier EOB. I have to keep MEOB in my vocabulary because that is what Bankers Fidelity uses.

For all but the Hospital claims, the MSN claim total line includes a reference to a footnote that reads:

We have sent your claim to your Medigap insurer. Send any questions regarding your benefits to them. Your Medigap insurer is XXXXXXXXX.

The Hospital claim MSNs do not not include that footnote. I know that means the Hospital bills the Medigap carrier because I got involved in one of those billings by the hospital to the carrier.

 

[rmhaire]

I was asking about the Medicare MEOB/MSN, not the carrier EOB.

Sorry. I saw EOB and ran with it.

As far as an MSN, I don't recall a footnote that says that. But I don't normally read them that close either.

I've got a filing cabinet full of the damn things. I'll pull a couple and get back to you.

 

[somarco]

No one has. It’s a common thing spread around here.

There is a Georgia agent that has stated such. In a thread about hospital MCO contracts cancelled/non-renewed he posted that the impasse did not affect doctors.

 

[straightnochaser]

I know everyone (most) on here hate on call centers but situations like this where someone is so green and new that they don't understand the basics is where a call center would be a good headway into the industry (no offense OP)

 

[Dave G]

Yet more reason to avoid Advantage plans. My client in SC with Original Medicare and his Plan G got the care he needed for neck cancer at Sloan Kettering....no problem.

Advantage PPO plan lovers don't realize providers must still accept Medicare and agree to bill the plan. And the client pays from 30% to 50% depending on the plan in co-pays....not even as good as 20% with NO Medigap plan. Plus, MOOP can run $8,000 to $12,000. Advantage plans can be an expensive way to save money.

 

[maxherr]

There are very few hospitals that don't accept Medicare patients, because they need the money. But specialty hospitals, like some that only treat cancer patients . . . sometimes with therapies that Medicare would not consider covered . . . are among those that don't. To say to anyone, "You can see any doctor or go to any hospital in America," is a flat-out lie. The proper statement is, as it is with Medicare Supplement plans, "You can receive care or treatment from any doctor or facility that accepts Medicare patients."