.gif)
Medicare Advantage may offer some additional bells and whistles for you, but these plans also come with some challenges. If you still are not sure which way you should go, make plans to attend the Nov. 6 ABC’s of Medicare and Medicare Advantage Plans.
The event will be held at the Columbus Wellness Center Community Room at 10:00 a.m. The program is designed to gain detailed insights to make informed healthcare decisions for the annual enrollment period this fall.
You may be aware from the bombardment of ads for Medicare Advantage plans on TV and radio that now is the time for Medicare Open Enrollment through Dec. 7.
We want to give you some additional information to help you make an informed choice on your health insurance. The advertisement is a comparison between traditional Medicare and Medicare Advantage.
It is important to note that Medicare Advantage is not the Medicare that we have all known for years. It is 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 company.
For some, especially those who are very healthy, Medicare Advantage may 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 a rural hospital open as well as difficulties recruiting doctors to rural areas. Traditional Medicare understands these challenges, and has some additional reimbursements for rural hospitals, while some Advantage plans want the hospital to contract for rates lower than the Medicare rates, and without the additional reimbursement.
Rural areas have limited specialists that come to our area or are ones that we know and trust to give you good care. Advantage plans have a limited panel of specialists to choose from and on occasion, we have had to refer patients to a specialist on the other side of Houston as the closest option, or to a doctor we do not know.
Suppose you come in with abdominal pain and your doctor decides you need a CT scan. If you have Traditional Medicare, we call the radiology department to pick a time for your scan. Our only limitation is the schedule for the procedure.
With an Advantage plan, we have to get the insurance company’s authorization first, which can take days, and then can schedule the procedure, if the company approves.
And, what if you need to be hospitalized, and then need to go to a rehabilitation facility after that to help you get back to your old strength? It is much more difficult to find a rehabilitation facility that accepts your Advantage plan and the plans frequently deny the need for the services.
Hospitals, clinics and rehabilitation facilities accept Traditional Medicare all over the USA, but Advantage plans are limited to a specific geographic area and may not cover you on your trip to Las Vegas or on your business or vacation trip. Since we are halfway between Houston and Austin, we even see problems with plans that stop at the county line, and Columbus facilities are not on these plans.
One last thing is that if your health declines and you have previously been on an Advantage plan that is no longer working for you, you can switch back to regular Medicare during the open enrollment time, but you may not be able to find a reasonably priced supplement to go with it due to your pre-existing conditions.
