Connections between Medicare & Medicare Advantage Plans

Medicare (CMS, BCRC, CRC, or any other contractor) does not speak for Medicare Advantage Plans (“MA Plans”). MA Plans do not speak for Medicare. These two statements could not be more important as MA Plan providers like Humana become more aggressive in suing to enforce their Medicare Part C liens.

Last week, an attorney asked us – regarding an Optum MA Plan – “I think they are also saying that ‘the Plan will provide benefits for future necessary incident related treatment.’ Doesn’t this now mean that there is no need for a MSA?” No. The Optum statement has no bearing on the MSA.

The correct analysis requires a better understanding of Optum’s role in the case. Optum is not pursuing recovery for Medicare (regular Medicare Parts A & B). Instead, Optum is pursuing recovery for its own UnitedHealthcare Medicare Advantage Plan lien (Medicare Part C). Generally, a Medicare Advantage (or “MA Plan”) can be considered something of a replacement for Parts A & B. That statement gets a little murky though because some Part C plans are in fact just supplemental (or GAP plans) and some Part C plans are/were only in effect for part of the treatment period.

Optum’s release for the case in question is great language to avoid any confusion on Optum’s specific claim. It has no relation to regular Medicare’s claim.

The simplest Medicare Set-Aside analysis still exists: If future treatment is necessary and regular Medicare is on the hook for it, then you likely need an MSA. A true analysis is much more detailed and defined than this sentence, but we only have so much space in a blog post! Optum’s release provides no comment on whether regular Medicare will be on the hook for any future care.

If you are uncertain as to whether you need an MSA for any case please consider an MSA Opinion letter drafted by one of our MASSIVE attorneys. If you would like to consult with a Medicare Set Aside expert, give us a call at 844.633.5436.