Basic Medicare Advantage Plan Information That Everyone Should Be Aware Of

Medicare Advantage Plans are an additional option for getting Medicare Part A and Part B coverage. Medicare Advantage Plans, often known as Part C or MA Plans, are provided by Medicare-approved private organizations that must agree to Medicare requirements. The majority of Medicare Advantage Plans provide medication coverage (Part D). These plans restrict your extra expenses for covered health services each year.

A few plans provide non-emergency coverage outside of the network, but only at a greater cost. Remember that you must utilize the Medicare Advantage Plan's card to obtain Medicare-covered services. Save all the types of Medicare cards somewhere secure because you'll need them if you ever return to Medicare Advantage.

Process for Enrolling in a Medicare Advantage Plan

All Medicare Advantage Plans are not created equal, so there is a working difference among them. Before you sign up, look for and start comparing Medicare health plans in your community or nearby area. Here's how to enroll after you've familiarized yourself with the plan's regulations and costs:

•  Use Medicare's Plan locator to choose a plan that meets your needs.
• To determine if you can enroll in the plan online, go to its website.
• Complete a paper enrollment form with accurate details. To get a registration form, contact the plan.
•  Submit it to the plan once you've completed it with the required information. This is a requirement for all plans
•  Call the plan for which you wish to register. 

In most cases, you can enroll in one of the following Medicare Advantage Plans:

•              Preferred Provider Organization (PPO)
•              Health Maintenance Organization (HMO)
•              Private Fee-for-Service (PFFS)
•              Medical Savings Account (MSA) Plan

Hierarchical Condition Category (HCC) Gap Closure Program

An HCC is a set of diagnoses that the Centers for Medicare & Medicaid Services utilizes in its risk-adjusted payment model for Medicare Advantage plans. These codes are the most important markers of a participant's health condition, especially the chronic conditions.

Connecting with a risk adjustment analytics provider is a must, as a healthcare provider can assist health plans in finding and closing gaps in patient care, both retrospectively and prospectively. Healthcare related analytics provides health plans with data sets that may be used to boost HCC code capture, help with HCC Close Gaps found in code capture, and target patients based on HCC Close Gap potential. Insights may also help to eliminate HCC gaps that clinicians were unable to complete, and the data can be used to build a client deficit letter in advance to record diagnoses at the next appointment and effectively manage care services.