Medicare Supplement Plan & Kaiser

Yes it's true, I have a couple dozen clients in that area and they will not accept Medicare. I'm not sure why you would think it's illegal though.

And nothing is normal in the villages. It's Disney world for seniors. Golf everywhere and non stop golf carts everywhere. Herpes runs rampid as well! Lol at least that's what a news article said

I admit I don't work the Medicare market, but I am confused how a provider could accept a MA plan, yet not accept regular Medicare. You would think they are part and parcel. I completely understand choosing to accept only one MA plan or not accepting Medicare in its entire. I am just surprised that it is possible to accept MA in any fashion but not regular Medicare.
 
Accepted Insurance by The Villages Health

This looks like it might be what is being discussed.

(clicking on United Healthcare line in upper rt corner of screen goes to a screen that includes a video. I did not watch it, but it may be the video being referenced.)
 
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Accepted Insurance by The Villages Health

This looks like it might be what is being discussed.

(clicking on United Healthcare line in upper rt corner of screen goes to a screen that includes a video. I did not watch it, but it may be the video being referenced.)

It is the correct website, The video is a different video than the clients showed but it is the correct plan and show they do not accept original Medicare but only MA plans listed
 
I admit I don't work the Medicare market, but I am confused how a provider could accept a MA plan, yet not accept regular Medicare. You would think they are part and parcel. I completely understand choosing to accept only one MA plan or not accepting Medicare in its entire. I am just surprised that it is possible to accept MA in any fashion but not regular Medicare.

A doctor accepting Medicare assignment is one thing, and agreeing to the MA Plan's terms and conditions are another. To my understanding, a doctor does not have to accept assignment to take MA Plans.

I know it doesn't make much sense to us, but I suppose they have their reasons for not accepting assignment.
 
A doctor accepting Medicare assignment is one thing, and agreeing to the MA Plan's terms and conditions are another. To my understanding, a doctor does not have to accept assignment to take MA Plans.

I know it doesn't make much sense to us, but I suppose they have their reasons for not accepting assignment.

I am willing to accept that obviously there must be a way. Just very surprised you can choose to accept MA but not Medicare.

I have no doubt as to their reasons. They are probably getting a sweetheart deal from UHC over it.
 
i enjoy this type of thought provocation! very interesting, indeed. i believe you're accurate too. Kaiser is an MA provider so they would have to take it. do you plan on executing this with a client?

I was posed the question by the daughter-in-law of a Medicare beneficiary. It seems logical to me, I just don't know if it would fly.
 
I admit I don't work the Medicare market, but I am confused how a provider could accept a MA plan, yet not accept regular Medicare. You would think they are part and parcel. I completely understand choosing to accept only one MA plan or not accepting Medicare in its entire. I am just surprised that it is possible to accept MA in any fashion but not regular Medicare.

This particular group worked out a deal with UHC/AARP to only accept their Medicare Advantage plans beginning in 2017-they grandfathered anyone with other MAPD for 2016 but no longer take any other plan.

It's easy to speculate how they can get away with this but the reality is that they are doing it in full view of the public and in partnership with the largest national Medicare provider (UHC) both on the MAPD and Medicare Supplement side so it is clear that there are no legal issues.

There are many ethical issues, of course, and this has not gone over well within The Villages community, which is very insulated in terms of both location (in the middle of Florida and not near any population center-Orlando is the closest metropolitan area and it's about a 90 minute drive) and demographics (all 55+, mostly retired).

I doubt that this approach would work for a medical group in a mtropolitan area but The Villages is a special situation.
 
All providers and facilities opt out of Medicare.

One way it goes to US Govt and becomes appointed/certified --however that works-- as a Medicare Advantage plan...

The doctors are not violating any MedSupp acceptance rules because they have totally opted out of Medicare. They are just contracted with an HMO to deliver medical services, which they are doing.
Opt-out providers cannot participate in MA.

If you opt out, beware of the following:

- Opting out means you cannot be involved in any Medicare program; including original fee-for-service Medicare, Medicare Managed Care Plans, Medicare+Choice Plan and Medicare Advantage Plan.

Reference: https://med.noridianmedicare.com/web/jeb/enrollment/opt-out

As long as the provider has not formally opted-out of Medicare and is not sanctioned by the state licensing board, they can accept MA. Since the provider has not opted-out, they will be listed as a participating or non-participating provider with original Medicare. Participating and non-participating providers have the option of treating or not treating original Medicare beneficiaries in non-emergency situations. The participation agreement does not set a minimum number of OM beneficiaries the provider must treat. Only when the provider decides to treat an original Medicare beneficiary do the rules about filing claims and balance billing kick in.

Medicare Participation Agreement: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms460.pdf
 
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