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As the administrator for Columbus Community Hospital, I get to visit with members of our community during some of their happiest moments. And some of their most painful. Unfortunately, some of these more difficult moments happen when our senior patients can’t get the treatment or care their doctor recommends because they don’t have appropriate insurance coverage.
These seniors are on Medicare, but they’re enrolled in a Medicare Advantage plan, run by a health insurance company. These plans don’t have the same benefits or follow the same rules as traditional Medicare.
Medicare Advantage plans are hard to resist. They run frequent TV ads featuring wellknown celebrities. They offer extra perks such as gym memberships. They might be from the same company that you had coverage with before you retired. And, on the surface, they look like they might be cheaper.
But, there are gaps in coverage, and there can be hidden costs.
With traditional Medicare, you can see almost any doctor and go to any hospital, anywhere in the country. If you’re visiting grandkids in Dallas or North Dakota and need a doctor, traditional Medicare would have you covered. Medicare Advantage plans restrict which doctors and hospitals you can see to those they’ve picked to be in their network.
If you need home health care or medical equipment, like a lift or oxygen equipment, with Medicare Advantage, your doctor has to ask the plan for permission, a process that can take up to three days, and permission can be denied, meaning you either pay for it out of your own pocket or go without.
Most important, with traditional Medicare, your doctor decides with you what is medically necessary given your condition, prognosis and support. In a Medicare Advantage plan, those decisions are made by an insurance company employee who doesn’t know you or your doctor and may not even be a medical professional.
The team at Columbus Community Hospital encourages our Medicare-eligible residents to ask questions before committing to a Medicare Advantage plan. Ask if your doctor is an in-network provider. Ask about limits on coverage for hospital stays or rehabilitation. Ask about the process for getting approval for medical equipment or home health care. You can also attend one of our education sessions Oct. 12 or Nov. 16 with a professionalbenefits counselor from the Area Agency on Aging.
Medicare open enrollment begins Oct. 15, so now is the perfect time to start gathering information and talking to your health care team. From mid-October until Dec. 7, you can switch back to traditional Medicare or switch Medicare Advantage plans.
Everyone deserves choices in health care. And, making an informed choice about what’s right for you depends on having accurate and objective information.
Vanek is the CEO of Columbus Community Hospital.
