Medicare Advantage can be precisely defined as a U.S. health insurance program that is run under managed healthcare. The program was introduced as a substitute to the Original Medicare and is structured to offer parts A and B benefits. Part A benefits cater for in-patient costs and nursing services with the exception of services offered by surgeons and physicians. Part B benefits are a bit different in the sense they cater for payments to surgeons and physicians and any necessary outpatient services (eg, ER, X-rays and lab tests).
Original Medicare provides for the payment of claims through CMS (Centers for Medicare and Medicaid Services). On the other hand, Medicare Advantage issues payments through commercial insurance companies.
Overview and history
Medicare services have been in existence since 1970s and beneficiaries have been given several options to choose from. For example, one can choose to enroll for the Medicare Advantage plans or use Original Medicare, which provides a completely different method of compensation. Medicare plans are paid through bidding processes and these bids are submitted depending on the cost estimated for each enrollee of services included in Parts A and B.
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Additionally, there is a benefits package that is availed for Medicare Advantage users. Each plan offers a specific out-of-pocket cost for similar benefits as offered under Medicare Advantage. Some of the services that may raise the out-of the pocket amount include skilled nursing facility. So, to lower the overall cost, the facility may opt to offer lower copayments for future doctor visits.
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There is also a maximum out-of-pocket amount, usually $6,700 annually. Reaching the maximum out of pocket amount means the plan should cater for all other services 100 percent as long as everything is done within the confines of the regulations of the program.
InnovaCare is a leading provider of managed healthcare services that serves the North American region. The company deals with the primary avenues of care namely Medicare Advantage and Provider Networks. Through their effort, many people have been able to access quality healthcare through sustainable, cost-effective and integrated models.
Dr. Rick Shinto, the current President and CEO of InnovaCare Health, is an experienced operational healthcare and clinical health professional with more than 20 years in the industry. Rick Shinto has also headed several other companies including Aveta Inc. Through his leadership, InnovaCare Health has grown into a well networked company across the whole of North America.
Penelope Kokkinides, InnovaCare’s Chief Operating Officer, is a focused professional with great experience in developing clinical programs. He has worked with InnovaCare for several years and his experience in healthcare practice spans more than 20 years.