It’s that time of year when eligible individual have the chance to sign up for a Medicare Advantage Plan — or change from one plan to another or switch back to traditional Medicare.
Open enrollment for Medicare Advantage Plans runs October 15 through December 7 this year. But before you sign on the dotted line, be sure the plan you’ve chosen has you covered. If your doctors and hospital are not in the plan’s network of providers, you could end up paying more for medical services.
There are several options in our market area, if you decide an Advantage plan is right for you. But don’t assume because it’s an AARP-endorsed company that it’s looking out for your best interests or that it’s the best possible choice for you.
“Most people have no idea they have to ask to find out if their health care providers are in the insurance company’s network,” said Jeff White, Beaufort Memorial Hospital’s senior vice president and chief financial officer. “If they’re not part of the plan, you’ll have to pay more out-of-pocket costs—and they can be substantial.”
Sometimes called “Part C” or “MA Plans,” a Medicare Advantage Plan is another health plan choice you may have as part of Medicare. They are offered by private insurance companies and provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage.
Medicare Advantage Plans pay for all of the services that Medicare covers, including emergency and urgent care. These plans are NOT supplemental coverage, but they may offer extra benefits, such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Although participating insurance companies must follow rules set by Medicare, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services. For instance, you may need a referral to see a specialist or you may be required to go only to doctors or facilities that belong to the plan for non-emergency or non-urgent care.
If you are treated by a doctor or hospital that doesn’t belong to the plan, your services may not be covered or your costs could be higher.
Check with the insurance company to find out if they will cover a particular service and what your costs may be before obtaining the service, if possible. You may be required to obtain prior approval for certain procedures to avoid higher costs.
Since not all Medicare Advantage Plans work the same way, it’s important to find out the rules and costs of a plan—and if your doctors and hospital are in the plan’s network of providers—before you sign up. In most cases, you’re enrolled in a plan for a year and cannot change plans until the next open enrollment, which could be up to one year later.
“We’ve had patients ask us to write off the extra expenses they’ve been charged by their plan because we’re not in their plan’s network,” White said. “We don’t belong to some plans because the companies pay significantly less than our hospital-specific cost-based Medicare reimbursement.”
If you are already in a plan and do not select a different insurance company, you will be automatically re-enrolled in your current plan. Be aware, the plan’s rules and participants can change each year, so you’ll need to confirm your health care providers are still part of the insurance company’s network.
“Some insurance companies don’t advertise who is in their network and don’t tell you that you will pay more if you go to an out-of-network provider,” White said. “If you don’t ask, you may not find out until it’s too late and you have been charged extra for medical services because your doctor or hospital is not in the plan.”
If you want to confirm Beaufort Memorial participation in a specific Medicare Advantage Plan, call Robin Poehnert, manager of the hospital’s Cost and Reimbursement Department, at 522-5794.
