Medicare Advantage Plans and Prescription Drug Plans and How They Differ from Traditional Medicare

Under traditional Medicare, Medicare beneficiaries receive coverage through Part A (hospital insurance) and Part B (medical insurance).  Medicare beneficiaries may choose to enroll in a Medicare Advantage Plan under Part C as an alternative to traditional Medicare.  Medicare Advantage Plans are offered by private health insurers as a replacement for coverage under traditional Medicare.  If a beneficiary is enrolled in a Medicare Advantage Plan, the plan pays for the beneficiary's treatment that would otherwise be covered under Parts A and B.  In addition to benefits that are otherwise payable under traditional Medicare, some Advantage plans also provide prescription coverage.  Medicare beneficiaries may also receive prescription drug coverage by enrolling in a Prescription Drug Plan under Part D.  Like Medicare Advantage Plans, Prescription Drug Plans are offered by private health insurers.

It is important to keep in mind when resolving conditional payment claims, that the conditional payment letters issued by the Medicare Secondary Payer Recovery Contractor (MSPRC) only apply to payments made under Parts A and B of traditional Medicare plans.  They do not include information concerning Medicare Advantage or Prescription Drug plan liens.  If a claimant is enrolled in a Medicare Advantage or Prescription Drug plan, the identity of that plan should be determined and the plan should be contacted individually to determine whether it intends to assert a lien.