Are Your Senior Patients Aware of the Disadvantages of Medicare Advantage Plans?
Hospitals and Doctors Can Educate Patients about These Plans so They Can Make the Decision That's Right for Them.
By Barbara Carey and Mike McCall
Hospitals and doctors do not have to stand by when seniors are being bombarded by advertising for Medicare Advantage plans. They can be proactive and give them accurate information to help them make the best decision their health and quality of life.
Medicare Advantage plans will save money for seniors who are healthy and do not have chronic medical conditions. However, for seniors who require a lot of medical care, these policies can be more costly for the seniors and for the health care provider. The senior may pay more in deductibles and copays than Original Medicare and the health care provider will have to document reasons for referrals for procedures and specialty care. Perhaps they will have to do this more than once because denials are common.
Being proactive means presenting the information that seniors need in this complex world of Medicare. Here are some summary points that are included in our FACT SHEET that is part our Medicare Informational Tool Kit.
What Are the Advantages of Medicare Advantage Plans?
Low monthly premium that covers hospital, doctor and prescription drug costs
Preventive care coverage - hearing, vision, dental and sometimes gym memberships
Cap on annual out-of-pocket expenses for each enrollee
What Are the Disadvantages of Medicare Advantage Plans?
Tests and treatments must be pre-authorized by the insurance company Generally, referrals are required to see specialists
Patients select physicians and hospitals only from an approved network of providers
Patients get prescription drug coverage from an approved list Medical services only covered in a certain geographic area except for emergencies
Co-pays and deductibles may be higher than Original Medicare Medigap insurance is not available to cover out-of-pocket expenses
It is especially important that individuals who are enrolling in Medicare for the first time be informed. A patient who applies to Original Medicare can get automatic acceptance into a Medicare Supplement Plan called Medigap insurance. These policies pay for out-of-pocket healthcare expenses.
However, if a person switches from Medicare Advantage back to Original Medicare, they have to apply for Medigap insurance and can be denied for pre-existing conditions.
Help your patients understand the differences in Original Medicare and Medicare Advantage Plans so they can make the right decision for their healthcare needs.
Contact TCI for information on our Medicare Tool Kit!
We Help Our Clients Understand Their Environment and to Find Solutions.
Call Us 1-888-922-2824 or Email barbara@tciconsults.com
