Medicaid’s Medicare Advantage Managed Care Plan
There are currently four companies who contract with the Alabama Medicaid Agency and offer Medicare Advantage coverage in Alabama – United HealthCare’s Medicare Complete, Viva Health’s VIVA Medicare Plus and Blue Cross/Blue Shield of Alabama’s Blue Advantage and Windsor Health Care. When one of these companies notifies Medicaid that a Medicaid recipient has enrolled in their Medicare Advantage Plan, Medicaid makes a premium payment to the applicable plan. This payment covers all Medicare coinsurance and deductibles. Therefore, neither Medicaid nor the recipient
will pay any co-payments, coinsurance or deductibles for Medicare services incurred during the time that the individual is enrolled in Medicaid’s Medicare Advantage Plan.
Claims can be submitted to Medicaid for copays, deductibles or coinsurances for dates of service that are prior to or after the dates that Medicaid has paid a premium to one of the four Plans listed above. These claims should be billed on a Medicare/Medicaid crossover claim and will be processed like any other Medicare paid claim. (See Section 5.7.1 for specific billing instructions)
There are several Medicare Advantage Plans that are servicing Medicaid recipients. However, the four Plans mentioned above are the only ones with whom Medicaid has a contract to pay premiums. Since Medicare Advantage Plans pay in place of Medicare, any secondary claims to Medicaid for copays, deductibles or coinsurance should be billed on a Medicare/Medicaid crossover claim and will be processed by Medicaid in the same manner as a Medicare paid claim. (See Section 5.7.1 for specific billing instructions) The eligibility response from AVRS or Provider Electronic Solutions provides the following information if the recipient is enrolled in a Medicare Advantage
Plan for which Medicaid is making a capitation payment:
• Verification of the recipient’s enrollment in a Medicare Advantage Plan
• Plan telephone number
Claims for services covered under this plan must be filed directly to the applicable Medicare Advantage Plan.
