The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.
Medicare Advantage (also known as Medicare Part C) is a type of health insurance plan that is offered by private insurance companies and is approved by Medicare. It is an alternative to Original Medicare (Parts A and B), and it covers the same benefits as Original Medicare, but typically offers additional benefits, such as coverage for prescription drugs, dental, and vision.
With a Medicare Advantage plan, beneficiaries receive all their Medicare-covered healthcare services through the private insurance plan instead of through Original Medicare. The insurance company contracts with Medicare to provide these services and is paid a fixed amount by Medicare each month for each beneficiary enrolled in the plan.
Medicare Advantage plans may have network restrictions, meaning that beneficiaries must use healthcare providers within the plan’s network in order to receive benefits. They may also have out-of-pocket cost-sharing requirements, such as copays, deductibles, and coinsurance.
Beneficiaries who enroll in a Medicare Advantage plan typically still pay the Medicare Part B premium and may also be required to pay an additional premium to the private insurance company. In exchange, they receive a more comprehensive range of benefits than they would with Original Medicare alone.
It’s important to compare Medicare Advantage plans and consider your specific healthcare needs before enrolling in one. You can enroll in a Medicare Advantage plan during the Annual Enrollment Period (October 15 to December 7) or during a Special Enrollment Period if you meet certain criteria.