Medicare Advantage plans are provided by private insurers. Original Medicare is provided by the government. Medicare Advantage plans receive a fixed monthly fee to provide services to each Medicare beneficiary under their care.

These plans are usually health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Those only cover care from doctors in their network, or charge higher rates for out-of-network care.

The plans often look attractive because they offer the same basic coverage as original Medicare. Plus, many offer some additional benefits and services not offered by original Medicare.

Verify Network Provider Directories

Because Medicare Advantage plans have different coverage rules for out-of-network care, it is important to know which doctors and hospitals are in a plan’s network.

However, the Centers for Medicare & Medicaid Services (CMS) conducted a review of online provider directories for Medicare Advantage plans and found disturbing results. Incorrect information was listed for half of the 5,832 doctors in directories for 54 Medicare Advantage plans. That represented a third of all Medicare Advantage providers.

As a result of the review, CMS warned 21 Medicare Advantage insurers to fix the errors by Feb. 6, 2017, or face serious fines.

In 2016, CMS enacted a rule requiring plans to contact doctors and providers every three months to update their online directories. A Medicare Advantage plan can face a penalty of up to $25,000 a day per beneficiary if errors aren’t corrected.

Before purchasing a Medicare Advantage plan, you should double check with the doctors and hospitals you use. Make sure they are covered by the plan.

For an article from PBS.org about errors in Medicare Advantage plans, click here.

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