Mon, Mar 5, 2018

Top Five Reasons Seniors Don’t like Medicare Advantage Plans

It’s important to look before you leap when choosing your Medicare plan! Take time to read and discuss these options with someone who can advise you.

1. Getting coverage for procedures can be more complicated

MA plans are not for everyone. Because managed care plans aim to keep healthcare costs within budget, they try to prevent overuse through various means—such as “prior authorization” for surgery, home health care, hospital stays, and medical equipment. Your doctor will need to provide additional proof before your MA plan will pay for these services.

2. Billed before you receive treatment

How’s your healthcare budget looking? With MA you pay copays before treatment. So if you find yourself in need of multiple physician visits, you may end up incurring significant copays upfront before you even see the doctor or receive any care (versus owing a 20% coinsurance that would be paid by your Medigap policy if you had Medicare-plus-Medigap).

3. Less freedom in choosing healthcare providers

With Original Medicare, you can choose to see any physician who accepts Medicare. This means that you can access major medical centers nationwide. On the other hand, MA plans are more restricted in terms of the provider networks they work with. A network is a list of doctors, hospitals, or pharmacies that negotiate prices with insurance companies. Depending on where you live, it can be difficult to find a local doctor or hospital that works with MA. If you see a doctor or visit a hospital that isn’t “in-network” with your MA plan, you will have to pay higher medical fees.

4. Not as compatible with other forms of retiree coverage

There are also some limitations in how MA works with other types of retiree coverage. For example, beneficiaries with Tricare for Life need to enroll in Original Medicare (versus MA) in order to keep their Tricare coverage. Before you enroll in an MA plan, be sure to explore how it will work with other types of retiree coverage you may be using.

5. If you change your mind and want to switch back to Original Medicare, there could be issues.

You can only switch between an MA plan and Original Medicare once a year, during the annual 7-week Medicare Open Enrollment period from October 15 through December 7. During this time, anyone with MA can drop it and switch to Original Medicare.

However, this leaves out a key fact. In most states, if you have been enrolled in an MA plan for more than one year, you are not likely to be able to enroll in the all-important Medigap policy, which helps many people fill the cost gaps in Original Medicare. At the very least, you may be subject to additional “underwriting” – an evaluation of your risk as a beneficiary. So be aware that if you stay on your MA plan for more than one year and then try to switch to Original Medicare, your Medigap choices may be limited or nonexistent.

The key takeaway? It’s important to look before you leap when choosing your Medicare plan! Take time to read and discuss these options with someone who can advise you.  FirstCommunity is happy to sit down with you and go over your options based on your situation and your current health status. Although wading through all of this information can be frustrating, it can make a huge difference to your health and finances for years to come. Take a look at "What you need to know about Advantage Plans" on our home page for more info or just give us a call at 256-532-2783.

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