Module 2 - Medicare Advantage Medicare Saving Account Plans Flashcards
What is a Medicare Saving Account (MSA) Plan?
– A Medicare MSA is a high-deductible health plan which is combined with a savings account used to pay for health care expenses during the deductible phase.
- Medicare contributes money to the beneficiary’s savings account to assist with paying for health care expenses during the deductible phase.
The deductible applies even in the case of preventive services that have no member cost-sharing under other plans. If the member is in the deductible phase, they must pay for these services.
MSA enrollees pay for health care expenses from the savings account and then, if they use all the funds in the savings account, out-of-pocket.
After the annual deductible is met, the plan pays 100% for covered services.
- The maximum allowable deductible for MSA plans in 2023 is $15,750. However, most MSAs will have a substantially lower deductible.
What are some major characteristics of a Medicare Advantage MSA plan?
– MSAs cover Part A and Part B benefits after the deductible
– MSAs do NOT cover, Part D Medicare prescription drug benefits
- MSA enrollees must enroll in a stand-along PDP if they want prescription drug benefits
– MSA enrollees may receive covered services from any Medicare-approved provider in the U.S. if the provider chooses to accept their plan.
–MSAs may not have a network or may have a full or partial network of providers.
– All non-network providers must accept the same amount that Original Medicare would pay them as payment in full. This is the amount the enrollee will pay the provider before the deductible is met.
– In 2023, MA MSA plans were only available in 36 states and the District of Columbia.
Do MSAs cover Part D Medicare prescription drug benefits?
No. MSAs do NOT cover, Part D Medicare prescription drug benefits.
- MSA enrollees must enroll in an stand-alone PDP if they want prescription drug benefits.
Do MSAs cover Part A and Part B benefits?
Yes. MSAs cover Part A and Part B benefits AFTER THE DEDUCTIBLE.
Can MSA enrollees receive covered services from any Medicare approved provider in the U.S. if the provider chooses to accept their plan?
Yes. MSA enrollees may receive covered services from any Medicare-approved provider in the U.S. if the provider chooses to accept their plan.
Must all non-network providers accept the same amount that Original Medicare would pay them as payment in full?
Yes. All non-network providers must accept the same amount that Original Medicare would pay them as payment in full. This is the amount the enrollee will pay the provider before the deductible is met.
