How Will My Colonoscopy Be Covered if I Have Medicare And Humana Choice PPO?

1. 

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   Jason Goldenzweig

   Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada

   Humana Choice PPO would be a Medicare Advantage plan. When you are on Medicare and have a Medicare Advantage plan, coverage falls under the benefits described in your Medicare Advantage plan. It does not get billed to Medicare first and then to the Medicare Advantage plan carrier (in this case Humana) or vice versa. It would only be billed through Humana - the carrier pays their portion and you would be responsible for the portion dictacted by the plan benefits (e.g. you may be responsible for a deductible and then a coinsurance/copayment amount, etc.).
   
   Medicare Advantage plans are senior health insurance plans that work similarly to the under 65 health plans (deductibles, copays, coinsurances, max out of pocket expenses, networks, etc.). In short, the gov't pays the carrier x number of dollars for each enrollee under the plan and the carrier takes the risk of expenses. So when you have a claim, the claim gets processed through the carrier rather than directly to Medicare.
   
   Medicare Supplement plans (also known as Medigap plans) operate as a supplement (key work there - supplement) to original Medicare (your Part A & Part B coverage). When you have Medicare and a Medicare Supplement plan, the physician (or hospital or other facility) bills Medicare and then bills the carrier for their portion of charges - depending on which plan letter you have, you may be responsible for a small portion or nothing at all. The idea of a Medicare Supplement plan is to create a predictable expense structure for your healthcare needs rather than taking on a larger portion of risk of expenses on claims. Plus, the Medicare Supplement plan structure allows you to go to any doctor that takes Medicare, meaning no networks and they are not restricted to annual enrollment periods like Medicare Advantage plans are.
   
   If you want to take a look at a Medicare Supplement plan to see how it compares, I can help you with that. The Medicare Advantage Disenrollment Period (MADP) is from January 1 - February 14 of each year so you have an option to change if you decide to do so. Please note, depending on several factors, you may or may not be subject to medical underwriting for a Medicare Supplement plan (e.g. whether you are new to Medicare, this is your first time in a Medicare Advantage plan, whether you have a guaranteed-issue right, etc. - I can help determine this). My contact information is cited on my agent profile - you can access it by clicking on the "contact me" button.
   
   I hope the information is helpful - please let me know if you have any other questions I can assist with. Thanks very much.

   Answered on December 8, 2015

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   Edward Crowe

   Owner, Crowe and Associates, Brookfield, CT

   Colonoscopy can be covered as a preventative benefit under the Humana plan if it is a routine procedure. If it is part of the regular preventative schedule there will be no cost to have it done. The trick however is that if anything is discovered or if a polyp is removed, it will no longer be billed as a preventative procedure and there will be a copy as a result. Most of the time it is billed as an outpatient surgery and you would need to pay the cost share applicable to it. A diagnostic Colonoscopy is going to be billed as an outpatient surgery.

   Answered on February 12, 2016

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