Seniors Urged To Be Careful With Medicare Advantage Enrollments
By Mike Scott
Northeast Missouri senior citizens are being urged to be cautious about enrolling in a Medicare Advantage plan. Many area residents have found out the hard way that the plans they purchased may be useless.
Medicare Advantage plans are being sold to senior citizens as a lower-cost replacement for their “Medigap” or supplemental plans. The problem, however, is that the Advantage plans are so new that many rural medical providers are not enrolled to accept them.
The original Medicare Plan is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.
The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.
Advantage Plans operate like an HMO or PPO plan, where the providers must enroll and accept what the plan pays for the service. Usually this results lower monthly premiums than “Medigap” policies, but many seniors don’t understand that they don’t cover everything, such as co-pays.
“They’re not used to paying anything, and it’s a rude awakening for them,” said Pat Selby of the Retired and Senior Volunteer Program in Kirksville.
In some cases, area senior citizens have enrolled in an Advantage plan, and then went to their doctor or hospital, only to find out later that the provider does not accept that plan.
“If you’re looking into one of these plans, check with your doctor and hospital first to make sure they accept the plan,” said Selby.
“And just because they accept the plan this month, doesn’t mean they will next month,” she cautioned.
Once enrolled in an Advantage Plan, seniors are no longer part of the Original Medicare Plan. The good news is that during the first year, they can disenroll in their plan and be guaranteed their previous supplement will issue coverage for them. After that, it may be harder to get supplemental coverage again, depending on your health condition.
The Medicare Advantage Enrollment periods run from January through March.
“If it sounds too good to be true,” said Selby, “It probably is.”