Medicare Advantage Plans Impact Upon Liability and WC Claims

Medicare Beneficiaries Show Significant Increase in Participation in Medicare Advantage Programs

For payers (insurance companies, self-insured organizations and TPAs) handling liability and workers’ compensation claims, it has become more important than ever to include in the claim handling process the investigation of the injured person’s Medicare beneficiary status. Cases have held that in addition to the governmentally operated Medicare, privately insured Medicare Advantage Plans are protected by the Medicare Secondary Payer Act. These entities by definition of the federal government are afforded protection s Secondary Payers. Primary claim handlers for liability and workers’ compensation must at all times, including settlement, protect the interests of Medicare and by extension Medicare Advantage programs.

A recent article by Flagship Services Group indicates that the percentage of Medicare beneficiaries also enrolled in Medicare Advantage programs has risen since 2005 through 2016 from 8% to 33%. The percentage of participation is predicted to increase to 50% in the coming years.

Payers must embrace this increased exposure and the large increase in handling time / processes for claim handling to ensure that the interests of Medicare are considered during the process and particularly if a settlement is considered. Client organizations will need to embrace these additional tasks / costs when considering pricing of professional services as well.