Medicare Advantage Plans – What Are They? 

Medicare Advantage Plans (MAPs), also referred to as “Part C” plans, are offered by private insurance companies contracting with Medicare to provide coverage to beneficiaries. Because they are offered through private companies instead of Medicare directly, MAPs are notoriously difficult to identify. There is no central repository for determining who is a recipient of a MAP. Some estimates suggest that one-third of all Medicare beneficiaries are enrolled in a MAP. 

Why Do We Care? 

MAPs lay in wait, convincing the insurance industry they don’t exist. Then, when a claim settles and a MAP lien is not resolved out of the settlement proceeds, Medicare goes after not the claimant but the insurers themselves. This leaves private insurance companies offering Part C plans significantly liable to damages by Medicare. This includes monetary damages up to $1,000 a day or $100,000 per year for each day the lien goes unresolved.

The Good News for Insurers

Thankfully, MAPs may no longer hide. On December 11, 2020, President Trump signed into law the Provide Accurate Information Directly (“PAID”) Act. This law amends 42 U.S.C. §1395y (b)(8)(G) and requires that CMS expand its Section 111 query process. The PAID Act now requires CMS to provide the names and addresses of any such Medicare plans as part of the Section 111 Query Process. That requirement makes it much easier to identify those beneficiaries holding Part C plans. CMS has one year to implement the changes, with a deadline of December 11, 2021.