By Jeffrey White
Medicare/Medicare Advantage plans are open to change enrollment now through December 7. As a result, you have probably seen advertisements for many Medicare Advantage plans.
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 the best possible choice for you.
What you need to know is which providers belong to the plan’s network. A doctor or hospital “in network” is one that negotiates a formal contract and provisions for reimbursement. This is important because, if you receive services from a doctor or hospital out-of-YOUR-network, you may find yourself with less coverage and paying much more out-of-pocket than you bargained for!
Medicare Advantage plans are not supplemental plans, they actually replace traditional Medicare. 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. Or you may be required to obtain prior approval for certain procedures to avoid higher costs.
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.
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.
Insurance companies offering Medicare products may say you are free to choose any doctor or hospital, but some fail to let you know that you may pay more for medical care by providers (doctors and hospitals) not in their network.
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.
Beaufort Memorial Hospital participates in five Medicare Advantage Plans. They are:
• Medicare-Ambassador PPO (MCR Advantage plan under America’s 1st Choice)
• Medicare-Blue (MCR Advantage PPO plan)
• Medicare-Humana Choice PPO (MCR Advantage PPO plans)
• Medicare-Humana Gold Choice PFFS (MCR Advantage plan)
• Medicare-Patriot PFFS (MCR Advantage plan under America’s 1st Choice)
To find out more about plans available in the area, go to www.medicare.gov and enter your zip code. If you want more information about Beaufort Memorial’s participation in a specific Medicare Advantage Plan, visit www.bmhsc.org or call Robin Poehnert at 522-5794.
Remember, you only have until December 7 to choose a different Medicare Advantage plan, or you may choose to switch back to traditional Medicare. Whichever you choose, make sure you know what you are getting before you sign up and that you understand the implications and requirements of joining a particular Medicare Advantage plan.
Jeffrey White is Senior VP and CFO at Beaufort Memorial Hospital.
By Jeffrey White