Medicare Advantage Plans And InnovaCare Health

Medicare Advantage Plans are private Medicare health plans. There are several types including Health Maintenance Organizations (HMOs). They provide Medicare-related services to members. These are private companies but are paid by the federal government.

All Medicare Advantage Plans include a limit on their out-of-pocket expenses for Part A and Part B. The maximum out-of-pocket amount for a HMO is $6,850. Cost-sharing that is higher than Medicare isn’t allowed; this includes co-pays or coinsurance for certain types of services including chemotherapy and dialysis. Medicare Advantage Plans cover vision or dental care, but Medicare doesn’t.

Medicare doesn’t cover everything. After emergency and urgently needed care, most Medicare Advantage Plans won’t continue covering expenses for hospice care. In fact, services that are medically unnecessary won’t be covered. To ensure that the services you need are covered, check with your provider.

There are prescription benefits available as part of the Medicare prescription drug coverage, also known as Part D and costs $104.90 a month.

Read more: Rick Shinto | LinkedIn

There are several places to get Medicare Advantage Plans. InnovaCare is one. It is run by Penelope Kokkinides, the Chief Administrative Officer. Rick Shinto is the President and Chief Executive Officer. The company has a few Medicare Advantage Plans in Puerto Rico. The first is called MMM Healthcare and the second is called PMC Medicare Choice. In total, InnovaCare Health has 200,000 members and 7,500 providers. Members report a satisfaction rate of 99 percent. The disenrollment rate has dropped by 40 percent since last year. More people are undergoing preventative screenings as well. MMM and PMC are the only health plan providers that earned the National Committee for Quality Assurance (NCQA) in Puerto Rico.

InnovaCare also runs a Physician Practice Service called MSO of Puerto Rico, Inc. InnovaCare offer several services including contracting, claims processing, provider relations and coordinated care. Providers can conveniently access a web portal with 24-7 access. InnovaMD provides a direct link between the provider and related departments. It is the first information exchange hub in Puerto Rico that can connect all electronically certified health records. Here’s some of the information available to providers:

Patient eligibility for members

Payment history

Provider directory

CPT4, ICD-9 and HCPCS Codes

Creation of electronic referrals

Online MSV

Downloadable formularies

Downloadable clinical guidelines

Downloadable news content

Electronic authorizations

Submission of claims with attachments

InnovaCare is based in Fort Lee, New Jersey. For more information on Medicare call 1-800-MEDICARE.

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