Medicare Advantage: Play it smart

Q. How can we strategically plan for the continued growth of Medicare Advantage Plans? 

A. The average Medicare beneficiary has 43 MAPs to choose from. More than 54% of beneficiaries participate in a MAP, and this is expected to grow to 61% by 2032. Why? MAPs are using celebrities to entice Medicare beneficiaries. Have you ever bought something after seeing an infomercial, a viral video or a TikTok, only to be disappointed that the “item” wasn’t quite as shiny as they made it out to be? Of course, you have! 

Here are some strategic actions you need to take as a supplier: 

Put on your detective hat 

Suppliers need to channel their inner Sherlock Holmes. Every contract with a MAP should be scrutinized like it's a mystery novel. Make sure you know exactly what the allowable is, whether it's a rental or purchase, modifier usage, or authorization requirements. Don't just accept "We follow Medicare guidelines”; they are required to comply with national and local determinations but may have different payment rules and reimbursement rates than traditional Medicare.  

Negotiate like a pro 

Keep in mind, not all orders are profitable. If the reimbursement isn’t acceptable, volume does not fix the profit margins. It's like trying to fill a leaky bucket – no matter how much water you pour in, it’s still going to leak. You are not required to accept every contract.  

Prior authorization 

For items that require prior authorization with traditional Medicare, make sure to get that approval and use it when submitting to the MAP. It's like having a VIP pass – it can make the process smoother. Think of it as your golden ticket to the Wonka factory of reimbursements. 

By being proactive, informed and strategic, we can navigate the growing landscape of MAPs. It's all about playing smart and staying ahead of the game.  

Kimberly Cuce is director of business optimization for VGM Group. Reach her at kim.cuce@vgm.com.