As most lawyers know, lien resolutions can be messy and confusing. While long waits and difficulty dealing with Medicare are almost inevitable, simply knowing the difference between certain programs can help lawyers expedite the process. Many lawyers often confuse the Medicare Advantage Plan and Medigap, so we’d like to set the record straight on what each one covers.
The Medicare Advantage Plan, for example is a Medicare health plan offered by a substitute private company, contracted by Medicare and funded by the government. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Since it serves the exact same function as Medicare, the same rules apply and, in NY, money must be paid back.
Medigap, also known as Medicare Supplement Insurance, is a separate program. Private companies sell Medigap coverage. It is additional insurance that covers co-pays and out of pocket expenses that Medicare does not. Medigap is classified as private insurance so funds do not need to be reimbursed in NY.
Clearing up the confusion and clarifying the distinctions between these programs is key for lien resolution because it can have a dramatic impact on lawyers and their clients getting access to the funds of the settlement. These resolutions are often frustrating and drawn-out because communicating and obtaining information from the Medicare and Medicaid offices can take a long time. Even if everything is handled promptly on the lawyers end, Medicare lien resolutions can still take more than 100 days to resolve.
What has been your experience in dealing with Medicare and Medicaid liens? Would a service that provides assistance in handling these liens be desirable? What other services would you be interested in getting help with? Please share your comments with us and let us know.