How Medicare works with separate Insurance Carriers

In the context of Medicare, the term "carrier" refers to the insurance company or organization that administers and manages the benefits provided by Medicare Advantage (Part C) or Original Medicare Parts A & B. A Medicare Advantage, Original Medicare or Part D prescription drug carrier is a private insurance company that contracts with the federal government to administer Medicare benefits.

Approved Centers for Medicare and Medicaid Services (CMS) Administrative Insurance Carriers such as private insurance companies not only manage the medical claims process, but also train clinicians to improve claim standards. In general, the carriers are accountable for the following duties: Preparing all Medicare claim submissions for the beneficiaries.

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies that are approved by Medicare. These plans provide all the benefits of Original Medicare (Parts A and B) and may also offer additional benefits, such as Part D prescription drug coverage, and ancillary benefits such as dental, vision, hearing, and wellness programs.

If you enroll in a Medicare Advantage Part C plan, you will receive your Medicare benefits through the private insurance company that administers the plan. These insurance companies act as carriers for Medicare Advantage plans. They contract with Medicare to provide Medicare-covered benefits to individuals who choose to enroll in their Medicare Advantage plans. The Medicare Advantage carrier is responsible for managing the plan, processing claims, and providing customer service to plan members.

Original Medicare carriers are private insurance companies that are contracted by Medicare and the federal government to process and pay Medicare Parts A and B hospital and medical claims. These companies are responsible for processing and paying claims for services and items covered under Original Medicare Parts A & B, such as hospital bills, doctor visits, diagnostic tests, and durable medical equipment.

An Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), is administered by the federal government through the Centers for Medicare and Medicaid Services (CMS).

CMS contracts with various private insurance companies to serve as carriers or administrative contractors at the regional or local level. These carriers process and pay claims, handle enrollment, and provide customer service for Original Medicare beneficiaries.

Both Medicare Advantage and Original Medicare carriers are responsible for ensuring that Medicare beneficiaries receive the benefits and services to which they are entitled. If you have questions or concerns about your Medicare coverage or benefits, you can contact your Medicare Advantage or Original Medicare carrier for assistance.