With open enrollment underway, people are beginning to have many choices in insurance policies. Medicare is a federal fee for service program, which pays for your part A and part B benefits. There is also a Part D program which covers the prescription drug plan.
One of the biggest and most confusing aspects is how Medicare compares to a Medicare Advantage program. A Medicare Advantage plan is administered by a private insurance company to which Medicare pays a set amount every month for each member. These are often an HMO (provides its service through a group of doctors, medical personnel and facilities that work directly for the HMO. The care of its patients is done at its clinics by its doctors) or PPO (allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.) Medicare advantage plans, as commercial insurance, follow Medicare billing guidelines, but not how the member will receive services.
Being a Neurological Rehab facility, the significant difference we see between Medicare and Medicare Advantage is with Rehabilitation Therapy (such as Physical, Occupational, and Speech therapy). Medicare does not require prior authorization if these services are needed. Most of the Medicare Advantage programs require prior authorization, and will be subject to medical review. We have found that the prior authorization process may limit the amount and intensity of therapy that can be received.
The above information is different from supplementary insurance plans. In these the supplement pays for the 20% that Medicare or the Medicare Advantage plan does not cover.
It is wise to research Medicare and Medicare Advantage plans before choosing a policy. For further information, or for information on your current plan, go to the following web page.
http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx
If you have questions please call Ericka at SWAN Rehab at 602-393-0520 and she will be happy to answer your questions.