For Successful Medicare Advantage Plans, Health Care Facilities Should Focus On HCC Close Gaps

Medicare Advantage (MA) is an integral part of the Medicare program that is available to enrolled beneficiaries, particularly the elderly and those with disabilities. Medicare Advantage Plans, commonly known as Part C plans, are provided by private health insurers recognized by Medicare instead of just the federal government. They provide the same hospital and medical coverage as Original Medicare Parts A and B, but do not cover hospice care.

The majority of Medicare Advantage Plans provide Part D Prescription Drug Coverage. Anyone who enrolls in a Medicare Advantage plan continues to have their Medicare coverage. In 2021, almost 26 million individuals, or 42 percent of those getting Medicare healthcare benefits, were registered in a Medicare Advantage plan.

Points To Note

Medicare Advantage, frequently referred to as Medicare Part C, is available to those 65 and over, as well as disabled individuals, who meet certain criteria.

Medicare-approved commercial insurance providers offer the plans.

With the exception of hospice care, coverage is the same as Part A hospital, Part B medical, and Part D prescription medicine coverage.

Companies get a predetermined monthly payment for plan care and might even charge policyholders for out-of-pocket expenses.

Each month, private organizations are paid a certain amount for Medicare Advantage Plan services. In response, these entities can charge members out-of-pocket expenses and impose their own service standards, including the necessity for referrals or provider groups for both non-urgent care and emergency care delivery. 

 

Certain Medicare Advantage Plans cover expenses that Medicare does not pay, such as eye, dental, and hearing-related charges. Medigap, often known as Medicare Supplement Coverage, does not operate with Medicare Advantage plans.

Participants in Medicare Advantage programs have their premiums paid for by Medicare.

Projected Premium for 2022

In 2022, the estimated monthly premium for a Medicare Advantage Plan is expected to be $19, down from $21.22 in 2021.

In comparison, the monthly health insurance premium and yearly standard deduction for Medicare Part B in 2021 are $170.10 and $233 in 2022, respectively.

What exactly is the HCC Close Gap?

Strong Hierarchical Condition Category Gap Closure, or HCC Close Gaps' solutions are being developed by the companies that provide health information technology. An HCC is a collection of diagnoses that CMS uses in its risk-adjusted payment model for Medicare Advantage plans. The HCC codes are the most important markers of a participant's health and help in risk adjustment. The vast majority of HCCs are comprised of chronic diseases. Diagnoses are extracted from claims information reported after a visit to an authorized healthcare provider.