Medicare Advantage

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Medicare Advantage private fee-for-service (PFFS) plans
PFFS plans are perhaps the most confusing and least understood of the various kinds of Medicare Advantage plans that are in operation. They also are the fastest growing type of Medicare Advantage plan. AMA has created a new one page flyer, 10 things you need to know about Medicare Advantage private fee-for-service plans  (PDF, 52KB). This flyer is for quick reference in a physician office to aid physicians and their staff about the basic operation of these plans. Free copies of this flyer are available for members only by contacting Private Sector Advocacy at 312-464-5490. State or specialty medical associations interested in co-branding this flyer may contact Steve Ellwing at 312-464-4367.

Important information about Private Fee for Service (PFFS) plans
CMS has posted on its Web site contact information for most of the major Medicare Advantage PFFS plans to allow physicians’ easier access to the plans’ terms and conditions.  AMA urged CMS to compile this information in response to physician complaints that they were having difficulty accessing these plans’ terms and conditions.  Visit the CMS Web site for contact information for all PFFS plans.

The AMA's Private Sector Advocacy (PSA) unit has developed the following tools to help physicians understand the program.

Medicare Advantage: What it means for you and your patients. (PDF, 621KB)

Physicians can use this booklet to begin to understand the many changes as a result of Medicare Advantage and to help their patients make informed decisions about the health care they receive. This booklet describes:

• Medicare Advantage Health Plan Options
• Regional PPOs and Regional Prescription Drug Plans
• Medicare Advantage Physician Participation and Contracting
• Medicare Part D – Prescription Drug Program

Special Needs Plans
Special Needs Plans are coordinated care plans that serve special needs individuals which include the institutionalized, dual-eligible, and chronically ill.  This brochure  (PDF, 109KB) provides information on the background of these specialized plans, defines each segment of this unique population, and gives information on how insurers offering these plans are funded.

Health Plan Funding and Physician Reimbursement
Medicare Advantage plans receive a fixed per-member-per-month payment from CMS, who in turn pay physicians on a contract or fee-for-service basis.  This brochure  (PDF, 104KB) provides detail on how insurer payment is determined and how physicians are reimbursed in coordinated care and private fee-for-service plans.

Prescription Drug Information
People with Medicare will be able to get prescription drug coverage through their choice of either a newly approved stand-alone prescription drug plan that works with traditional Medicare, or a Medicare Advantage plan that offers drug coverage and other benefits. You can visit the CMS Web site for information on this new benefit.

Regional PPO & PDP Breakdown
CMS has established 26 regions where MA Regional PPO plans can be offered and 34 regions where regional PDPs can be offered. PSA has created this downloadable flyer  (PDF, 289KB) to provide detailed information regarding the regional layout of both MA Regional PPO and PDP plans.

MA Plan Listing (2008)
CMS has approved Medicare Advantage (MA) plans for 2008. Physicians and their office staff can use this data to identify the HMO, PPO, SNP, MSA, PFFS health plans available in their area. The data can be sorted by state, county, insurer name, plan name, or by type of health plan offered.