What is a Medicare Consultant?

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  • Written By: Haven Esme
  • Edited By: Bronwyn Harris
  • Last Modified Date: 04 November 2019
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A Medicare consultant is a professional that can help an individual or company deal with aspects of the Medicare system. Medicare is a federally administered program that provides health insurance for people over the age of 65. The program can also help people under the age of 65 if they have certain disabilities or permanent kidney failure.

A Medicare consultant works with a company or individual to help them fully understand the Medicare program. When working with an individual, the consultant plays an advisory role and instructs the person on what Medicare carrier would be best for them. The consultant ensures that the individual has the perfect Medicare coverage to meet their health needs.

There are two main options that individuals can choose from when receiving Medicare. These options include the Medicare Part A and Medicare Part B. The options differentiate in price and medical coverage.

There are times that an individual may have difficulty paying for their Medicare health care or prescription drug coverage costs. In these cases, a consultant can help an individual with limited income and resources. The consultant can locate the right resources in order to receive the coverage needed.


The Medicare program has changed over the years. These changes are often referred to as Medicare reform. When Medicare reform takes place, the consultant must help companies and clients understand the implications of the change. A Medicare consultant can ensure that their clients are fully prepared to cope with any changes to the Medicare system.

Some Medicare service providers have a hard time getting reimbursed from the federal government after offering Medicare services to patients. This is especially true for home health agencies. A Medicare consultant can help companies with reimbursement information as well as developing reimbursement strategies. These strategies are essential for Medicare providers that are interested in maintaining a positive cash flow.

A Medicare consultant must also keep abreast of all developments in the Medicare system. A consultant will have special knowledge in Medicare coding, Medicare audits, billing, documentation, Medicare appeals, and Medicare compliance software. Medicare consultants come from a wide range of different backgrounds; however, many Medicare consultants worked previously in the insurance industry before entering consulting. Some consultants are also professional Medicare Hearings and Appeals Officers.


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