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You may be aware from the bombardment of advertisements for Medicare Advantage plans on TV and radio, now is the time for Medicare Open Enrollment. This window runs through Dec. 7. We want to give you some additional information to help you make an informed choice on your health insurance.
It is important to know that Medicare Advantage Plans are NOT the Medicare that we have all known for years. Medicare Advantage plans are an agreement between you and a private insurance company that is contracted with the government to save money on your care while still producing a profit for the private company. For healthy people without a frequent need for medical care, Medicare Advantage plans offer some additional benefits with lower cost premiums but there are limitations to the services these plans provide that may affect you should you need additional care.
There are significant challenges in keeping rural hospitals open and in recruiting doctors to rural areas. Traditional Medicare understands these challenges and provides additional reimbursements for rural hospitals to help them remain financially stable so they can continue to provide healthcare to their communities.
Medicare Advantage plans contract for lower payment rates to rural hospitals that do not pay enough to keep the doors open or the lights on. Rural areas like Colorado County have limited specialists that come to our area that we know and trust. Medicare Advantage plans limit which specialists you can see and frequently require our patients to travel to the other side of Houston to specialists that we do not know.
Suppose that you come in with abdominal pain and your doctor decides that you need a CT scan to find out what the problem is. If you have traditional Medicare, we only have to call the scheduling department and pick a time for you to get your scan. It is not so easy when you have a Medicare Advantage. Your doctor has to get the insurance company’s approval before many tests can be scheduled. This approval process can delay your care by several days. Medicare Advantage plans call also deny the request for your scan.
What if you get sick enough to be in the hospital and then need to go to a rehabilitation facility to help you get back to your old strength? Medicare Advantage plans make it much more difficult to find a facility that will accept their lower payment for your care. Medicare Advantage plans frequently deny that you need the service in the first place and will not pay for it. Hospitals, clinics and rehabilitation facilities accept Traditional Medicare all over the USA but Advantage plans are limited to a specific geographic area. We even see problems with patients who live in La Grange and have a plan that stops at the county line and cannot get service in Columbus.
Another issue to consider is that if your health declines and you have previously been on an Advantage you can switch back to regular Medicare during the open enrollment time. However, you may not be able to find a reasonably priced supplement to go with it due to your pre-existing conditions.
Our offices spend considerable amounts of time on websites, phone calls and filling out paperwork just to try to get our patients the care that the Medicare Advantage plans have promised to them.
You can see why some of us call them Medicare (Dis)advantage plans. They may offer some additional bells and whistles but it is important to know what you are losing by handing over your Traditional Medicare benefits to a private for-profit company.
If you still are not sure which way you should go, make plans to attend the Oct. 29, ABC’s of Medicare and Medicare Advantage Plans. The event will be held at the Columbus Wellness Center Community Room at 10 a.m. The program is designed to gain detailed insights to make informed healthcare decisions for the annual enrollment period this fall.
Toward your continued good health, Carl Dahlberg, MD, Bart Klaus, MD, Troy Millican, MD, David Neisner, MD, Rosemary Buckle, MD, Sharin Hajella, DO, Thomas Mueller, MD, Tom Hancher, MD
