subject: Regulations for Medicare Supplement Insurance Companies [print this page] Regulations for Medicare Supplement Insurance Companies
Most beneficiaries of Medicare prefer to get benefits via Medicare supplement plans. These are purchased from private insurance companies and regulated by the government. Beneficiaries often such plans since they have extra advantages and benefits than the Medicare insurance alone. However, governing bodies and authorities, such as Centers for Medicare and Medicaid Services, imposes some regulations on these insurance companies to make sure that the recipients are having the best health care there is.
The Centers for Medicare and Medicaid Services, or CMS, obliges all private companies to provide Medicare supplement plans that offer the basic coverage of services by the government Medicare insurance. This means that all plans must offer entire services of Part A and Part B. But, CMS allows insurance companies providing Medicare supplement plans to charge individually for these services and may require additional limitations. CMS also orders that all private insurance companies offering Medicare supplement plans must provide Part D, which covers prescription drugs.
Medicare supplement insurance companies must inform applying beneficiaries in written forms whenever there are modifications and changes regarding covered services and prescription drugs, which would be taken off from the formulary list. Such notifications can occur yearly if modifications or changes take place at the start of the benefit year.
Medicare supplement insurance companies also send out letters of notification to recipients if changes or modifications occur in the middle of the year. Whenever Medicare supplement insurance companies deny or restrict coverage for a certain service, they must provide the beneficiary with sufficient details of the case, as well as inform them about their rights based on their contract.
Medicare supplement insurance companies have to abide strict regulations regarding marketing. CMS stipulates such rules in order to avoid fraud and swindling cases. For instance, a private insurance company providing Medicare supplement plans cannot contact beneficiaries without their consent or permission. This prevents unsolicited phone calls, postal mails and emails. Companies cannot market services on establishments that provide free heath care and feeding programs. They also cannot claim that they are endorsed by the government agency providing Medicare.
Lastly, Medicare supplement insurance companies can restrict their beneficiaries to a network of providers, and refute coverage if the beneficiary seeks health care outside that network. But, CMS obliges Medicare supplement insurance companies to cover any emergency or urgent services even at out-of-network facilities.
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