We're thrilled to begin accepting Medicare Advantage in some states to make mental healthcare even more accessible across the nation!
When we're ready to enroll you in one of these plans, you'll receive an email from us. We're working hard to add new plans, so stay tuned!
Understanding the differences between Medicare, Medicare Advantage, and Medicaid
What are Medicare and Medicaid?
Medicare is a federally run program that covers medical expenses for more than 66 million Americans age 65 and older, as well as younger people who qualify because of a disability. Outpatient mental health services, which are provided through Headway, are covered by Medicare Part B.
Medicaid is run jointly by federal and state governments to provide health care and long-term care coverage for more than 81 million Americans, including children, parents, low-income adults, older adults, and people with disabilities. The federal government sets general standards for Medicaid, but specific eligibility requirements and coverage details vary by state. Your income must fall below certain levels to qualify.
What’s the difference between Medicare Advantage and Medicare?
Medicare, often called “Original”, “Traditional”, or “Fee for Service” Medicare, is provided directly by the government to beneficiaries. If you have Medicare, the federal government is responsible for your coverage.
Medicare Advantage is government funded and managed by private insurance companies. By law, these plans must offer the same minimum benefits coverage as Medicare, but are allowed to offer more benefits and can require higher premiums in exchange.
Original Medicare offers broad coverage with flexibility in provider choice, but requires additional plans for prescription drugs and supplemental coverage. Medicare Advantage, provided by private insurers, offers everything Original Medicare offers, with potential added benefits like prescription drug coverage and extras such as dental and vision, often at lower out-of-pocket costs. Typically it comes with network restrictions and potential limitations on provider choice.
The decision to choose Original Medicare or Medicare Advantage hinges on factors like cost considerations, desired coverage breadth, and provider preferences.
As a note: Patient populations for Original Medicare and Medicare Advantage are quite similar, and patient eligibility is the same for both.
What do Medicare Advantage plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers, except for hospice care.
How does Kaiser Permanente NorCal work?
To learn more about working with Kaiser Permanente NorCal on Headway, visit our article: Working with Headway and Kaiser Permanente Northern California.
Eligibility, enrollment, and opting out
Am I eligible to be credentialed with Medicare Advantage plans? What credentials do I need to accept Medicare Advantage with Headway?
At this time, we accept select insurance plans affiliated with Medicare; we do not yet support Medicaid. For a full list of Medicare plans supported today, you can search "Medicare" in the insurance carrier dropdown box on Headway.
I opted out of Medicare in the past. Can I still enroll in Medicare Advantage with Headway?
Yes – you can change your status. Here’s how:
If you opted out for the first time, you’ll have 90 days to notify your local MAC with a written, signed notice that you are canceling your opt-out.
If it’s been more than 90 days since your initial opt out, you’ll need to cancel your opt out by sending in a signed notice to your MAC within 30 days of your two-year opt-out period’s expiry date.
Documentation and training requirements
What are the training requirements to accept Medicare Advantage on Headway?
Accepting Medicare Advantage with Headway requires the completion of three annual training courses:
- Fraud, Waste, and Abuse training
- HIPAA training
- Writing compliant notes using Headway templates for Medicare
You can access these trainings within Headway Academy at any time.
What are the documentation requirements for accepting Medicare Advantage on Headway?
Documenting Medicare Advantage sessions can seem intimidating, but Headway is taking the guesswork out of meeting compliance standards.
When billing Medicare Advantage patients on Headway, providers are required to use our custom, Medicare-compliant templates, and will receive ongoing personalized feedback on notes from our clinical team to ensure documentation compliance.
Are there any general differences in documentation requirements for Medicare Advantage?
Medicare requires a diagnostic statement in your ongoing progress notes, a treatment plan within 14 days, and review of treatment plan every 3 months. Additionally, documentation of attempts to coordinate care with other healthcare providers is required.
All of these requirements will be captured in Headway’s documentation templates, so you don't need to worry about forgetting any requirements.
How will I know if my documentation is compliant?
Once you’re actively seeing Medicare Advantage clients, our team will proactively review documentation for Medicare Advantage appointments to ensure that all notes meet Medicare’s documentation standards. If we identify any errors, we’ll provide personalized feedback through your provider portal. You will have the opportunity to submit any necessary corrections to ensure that all documentation is compliant.
What happens if my documentation is found to be non-compliant?
If your documentation is found to be non-compliant, we’ll provide personalized feedback in your provider portal. You’ll have an opportunity to edit and resubmit. Between our proactive reviews and documentation templates, we’re here to make it as easy as possible for you to meet requirements.
Compliant documentation is legally required for Headway to submit Medicare Advantage claims. This means that if documentation is not received or doesn’t meet standards, claims will not be submitted and you will not be paid for these sessions. As a best practice, corrections should be submitted within 3 days of receiving feedback. Payment for sessions with non-compliant documentation will be held until the corrections are submitted and approved.
What Headway training can I use to advance my skill set in working with this population?
We’ve developed a new Headway Academy learning path specifically for Medicare practices to help you feel confident in running a Medicare practice.
Getting ready to see patients with Medicare on Headway
When can I start seeing patients on Medicare Advantage through Headway?
You’ll hear from us when you’re eligible to start the credentialing and onboarding process for Medicare Advantage. From there, we’ll keep you posted on when you can start seeing Medicare Advantage clients.
What steps need to be completed to be appointment-ready for Medicare Advantage on Headway?
To have your first appointments on Medicare Advantage, you’ll need to:
- Complete our Medicare Learning Path in Headway Academy
- Fraud, Waste, and Abuse training [60 minutes]
- HIPAA training [10 minutes]
- Writing compliant notes using Headway templates for Medicare [30 minutes]
- 2 other optional courses
How can I tell whether I’ve completed the onboarding training successfully?
You can view the completion of your Fraud, Waste, and Abuse, HIPAA, and Writing Compliant Notes trainings in Headway Academy.
Can I charge a cancellation fee for Medicare Advantage patients?
Generally, there are no differences in how and when you can charge cancellation fees with Medicare patients.
Please note: For Kaiser Permanente Northern California sessions, you are not able to bill a cancellation fee for no shows or cancellations. These additional fees cannot be charged on or off of the Headway platform. Learn more about working with Kaiser Permanente NorCal.
Clinical considerations
What are some of the key differences in treating Medicare Advantage clients?
There is no “typical” Medicare client. However, it’s important to understand there may be additional medical comorbidities and/or social determinants of health that have an impact on your clients’ mental health.
To manage these additional complexities, it’s best to ask the client if you can reach out to their other healthcare providers — especially any primary caregivers. Please note, if you intend to reach out to your client’s other healthcare providers, you should obtain consent from the client prior to reaching out. This is a best practice.
How can I best prepare to treat Medicare Advantage patients from a clinical perspective?
Medicare beneficiaries are eligible for coverage based on age and disability status, so it’s helpful to communicate with clients mindfully.
Ask for and try to communicate using their preferred medium and style.
Additionally, be aware of any other individuals involved in clients’ care, such as family or healthcare providers, as you may need to coordinate care with them.
As a Headway provider, you also have access to a PESI course titled "The Powerful World of Therapy with Adults 65 and Older: Challenging our Myths About Aging". To get started, visit our Continued Education page.
What are the outcome measure requirements?
While there are no specific outcome measure requirements for Medicare Advantage, we encourage providers to use measurement-based care and patient reported outcome measures where clinically appropriate.
Learn more in our Assessments and measurement-based care guide