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Medicare Advantage Frequently Asked Questions

May 2024

Our Patient Financial Services department frequently receives questions from patients about Medicare Advantage. Here are the top three questions and answers:

: If traditional Medicare covers services, why don’t Medicare Advantage plans, as they are required to follow Medicare guidelines?

: Medicare Advantage plans have their own conditions and limitations to determine if a service is considered medically necessary. There are other plan exclusions such as if the provider is out of state and/or not participating with that health plan directly. Each provider is responsible for requesting an organization authorization to receive coverage from the health plan. The final decision will be made by the health plan if they allow the organization authorizations and if they consider ForeseeHome medically necessary.

: What is the difference between traditional Medicare and Medicare Advantage plans?

: Traditional Medicare covers most medically necessary services and supplies and, in most cases, does not require a referral or authorization.

Medicare Advantage plans may offer extra benefits that traditional Medicare does not offer like dental/vision/prescription, but Medicare Advantage plans may have their own guidelines and limitations on covering services out of the preferred network or state.

If you are looking to switch plans, we ask that you contact our Patient Financial Services team in advance to review possible coverage changes.

: If I have a Medicare Advantage plan, can you also bill traditional Medicare?

: When you enroll in a Medicare Advantage policy, it will replace your traditional Medicare policy for part B benefits therefore we cannot bill Medicare.

If you have a question you would like answered in an upcoming newsletter, click here to submit.

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