The Relentless Marketing of Medicare Advantage Plans...
Hospitals Can Be Proactive Educating Seniors
By Barbara Carey and Mike McCall
It’s Medicare Open Enrollment from October 15 to December 7. Seniors are intensely marketed at this time by companies offering Medicare Advantage plans. Currently half of Medicare eligible individuals are enrolled in these plans. But for seniors with chronic health issues, those anticipating major procedures like a knee or hip replacement, they will end up spending much more on an Advantage plan than on Original Medicare. Most are not aware of this fact.
TCI strongly advises hospitals to be proactive and educate seniors on the differences in Original Medicare and Medicare Advantage plans. Medicare Advantage plans charge less on monthly premiums, but they restrict the provider network, require referrals and require copays which end up costing the plan participant a lot more than the savings on their premiums if they have chronic conditions. In Advantage plans patients may pay 20% coinsurance for a physician visit. If the patient has a chronic condition these charges can add up to hundreds if not thousands of dollars.
Original Medicare allows the patients to select any hospital or physician who accepts Medicare payments. In Advantage plans, patients must use designated provider networks and often must get a referral for specialty care. Waiting for a referral can delay care and the physician in the Advantage network may have a waiting list for patient appointments. Provider networks also change from year to year interrupting the continuity of care of patients with chronic conditions.
Advantage plans are also problematic and costly for hospitals with different rules than Original Medicare. Hospitals may incur higher administrative costs and longer payment cycles with these plans. The hospital and providers may not be included in their network at all. Negotiating with an Advantage plan with a large market share of a hospital’s patients is a daunting task, even for large systems.
What should hospitals do with Advantage plans blitzing seniors with celebrities and lower premiums?
Be proactive, fill the educational gap with the facts that seniors need to make a sound decision. Hospitals should help seniors compare the advantages and disadvantages of Advantage plans to Original Medicare. They can also help them to compare the total cost including out-of- pocket expenses, not just premium costs.
Every hospital has a substantial percentage of patients covered by Medicare plans. The hospital should absolutely communicate facts comparing Medicare Advantage and Original Medicare. A Medicare Fact Sheet with references to consumer information sources is a place to start. Post it on your web page and make it available in the hospital.
Hospitals can go to the next level and with videos with physicians explaining the differences between Original Medicare and Medicare Advantage plans. Post these on all of your digital communication platforms. Consider offering Medicare seminars in person or online to provide solid comparative information. For hospitals who want to be really proactive, informative direct mail pieces to seniors is another option. This population reads print material. Use social media to drive seniors to all of your communication pieces. If the only information seniors receive is from Medicare Advantage, they will not be making an informed decision.
It is for the benefit of the patient and the hospital that good decisions are made by this large group of consumers. The hospital wants their patients to be able to access their services and the services of their physicians. Restricted networks, coinsurance and copays are obstacles to care for many patients who are unaware of their Advantage plan restrictions. The costs of a proactive communication campaign are insignificant compared to the costs of Advantage plans or the risk of losing a large patient base of seniors.
Enrollment is going on now. Where do you start?
With a communication strategy that includes clear messaging and several communication platforms. Focusing on this issue will help seniors to continue to access quality healthcare from quality providers that they know and trust.
TCI can develop a strategy and provide communication tools that will help you to be more proactive in assisting seniors to make the right decisions for their health. We have a toolkit to make it easy.
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