Question about Medicare Advantage plans combined with Medicare Part B.

[justjoe]

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A patient has this CVS/Caremark MEDDADV plan. This is a Medicare Advantage plan, correct? So, to your knowledge, will plan cover any remaining copay for a medication billed to Medicare Part B? This would be albuterol nebs.

Thanks!

 

[zelman]

Medicare Advantage Plans are also known as Medicare part C. It is a single plan that covers whatever would be covered by A, B, and D. If they have this plan, you cannot bill part B.

 

[Subvisual]

Correct, the ADV stands for Medicare Advantage. Medicare Advantage plans are commercial plans that patients pay extra for that cover at the minimum everything Medicare A and B do. They also tend to have less annoying documentation requirements for the pharmacy (you can submit things electronically and don't necessarily need a DME Rx). Advantage takes the place of part B and you should submit claims to the Advantage Plan electronically instead of the usual paper claim Medicare B stuff.

Also Advantage plans can come with or without Part D drug coverage included.

 

[Old Timer]

I'm not 100% sure, just 99.99%. Caremark is a PBM and not an insurance company. Caremark as of now does not offer Medicare Advantage Plans. That may change with the merger with Aetna. Silverscript is only a Part D Plan. The MEDDADV, is just the PCN number for electronic billing to differentiate it from commercial plans.
The way Medicare Advantage plans work is that you give up regular Medicare and Medicare pays the Advantage plan a fixed amount of money. The plan then absorbs all of the costs of your care. The Medicare Advantage Plan frequently offers options not covered by Medicare A&B. Additionally, with Medicare Advantage Plans you do not have to by a supplemental policy to absorb the 20% not covered by Part B.

The catch is if you try to go back to Medicare and try to by a supplemental plan you will have to pay more if you have per-existing conditions.