"We Follow Medicare Guidelines" They Say…

Published in Complex Rehab on November 20, 2020

Many Medicare beneficiaries are being solicited by private insurance companies offering Medicare Advantage Plans via TV commercials. These Medicare Advantage Plans pose as Medicare and some of them even use celebrities to pitch their product. Read the fine print, as they are not affiliated with Medicare.

They are trying to convince Medicare beneficiaries to select their “Advantage Plan” over original Medicare Fee for Service (FFS) by stating they offer all the standard benefits of Medicare with a lower out-of-pocket cost.

But wait there’s more: These plans often state they provide additional benefits, such as gym memberships, transportation and eyeglasses. How can they provide more benefits with a lower cost? How can these private, for-profit insurance companies run all these TV commercials and pay celebrities and make a profit?

While some of these plans are good for the beneficiary’s needs and are fair to suppliers with reimbursement, many are not. Some are able to offer more for less due to an increased number of members, thus spreading the costs over a larger pool; however, many others are able to do this by not actually providing the same benefits as original Medicare.

Many of these plans don’t follow Medicare’s payment rules, and some attempt to pay for Complex Rehab Technology (CRT) wheelchairs on a rental basis, deny expensive electronics that are necessary to operate power positioning, and deny payment, thus plunging the CRT supplier into the labyrinth of appeals.

Read the full article from Mobility Management.