Quote:
Originally Posted by csx4910
Both of you have some valid points but just to add another opinion - I am a heath care professional (Respiratory Therapist) who own a durable medical equipment company (paid under part b) My insurance salesman you are quite wrong that the Medicare replacement plans(or whatever cool name you all want to give them) are not HMO's. They are much closer to the HMO family at least on the on the part B side than a PPO plan. The medicare replacement plans are NOT open to any medicare participating provider, since they give exclusive contracts to the lowest bidder to increase their profit. They restrict the Medicare patient from their choice (a Medicare hallmark) The contracts are capitated meaning that the provider is paid by the # of members a certain dollar amount whether they provie nothing, a beside commode, or a $15000 power wheelchair. The incentive is for the providing company to provide the least amount of service possible to maximize profit and to keep the costs fixed for the insrunace compnay. Often, senoirs find out too late that their premiums are higher with less coverage than they had with Medicare.
You sell the plans - we have to deal with what the reality of reimbursement with Medicare and the other plans after the fact. Would you be so hot to trot for these if you didn't receive a commission for them? What if you got a commission for selling Medicare? Would that change your story? And by the way, If I am signed up as a medicare provider I will NOT get paid if I treat and provide equipment for a Medicare patient.( I am not sure where you pulled that one from!)
Ron
Valley Respiratory Services
|
Try rereading from the top and add comprehension. IF by Medicare replacement plans [A TERM NEVER USED BY ME] you mean the actual HMO's a person can choose instead of Medicare. Then yes, they certainly are HMO's. If you mean any of the 10 standard Medicare Supplemental Plans, then no they are not HMO's. There is an alternative to the 10 standard Medicare Supplemental plans that is somewhat PPOish. Most of them are the same for part B, but have a participating hospital list under part A. These PPOish plans are called Medicare SELECT plans.
Then there are Medicare ADVANTAGE plans
From Medicare
Medicare Advantage Plans (like an HMO or PPO) See page 6.
• Run by private insurance companies approved by Medicare. • Provide your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. • If you want drug coverage, you must get it through your plan (in most cases). • You don’t need a Medigap policy.
Those plans might be your complaint, or maybe your complaint is that Medicare [not Medicare supplemental insurance] pays according to a fee schedule. If so, that is the US Govt's plan not any insurance company plan.
Also from Medicare:
Types of coverage that are NOT Medigap policies
• Medicare Advantage Plans (Part C), like an HMO, PPO, or Private Fee-for-Service Plans • Medicare Prescription Drug Plans (Part D) • Medicaid
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXX
A standard Medigap or Medicare Supplement plan and the Medicare Select plans ALL pay 20% of the Medicare approved amount [fee schedule] for PT and/or durable med. equipment. They are in no way involved in determining Medicare's fee schedule. If Medicare itself approves $200. the supplemental insurance pays $40. They do not care what the retail value could be, they do not determine if Medicare is over or underpaying for the treatment. They have to pay 20% of the Medicare approved amount.
Threaded Mode
