Medicare Advantage may not be
Open enrollment is time to study options
Staff writer
Anyone not satisfied with their Medicare, Medicare Advantage plan, or prescription drug plan has an opportunity to change Oct. 15 to Dec. 7.
Medicare is a health plan with two parts: Part A (hospital insurance) covers in-patient hospital and skilled nursing care, and Part B (medical insurance) covers physician services.
“Original Medicare is managed by the federal government,” Cindy Samuelson of the Kansas Association of Hospitals said. “This is the typical Medicare insurance most people are familiar with.”
Medicare typically costs about $165 a month. If the participant draws Social Security, the cost is deducted from monthly Social Security checks.
Some people pay extra for Medicare supplement insurance to cover copays and other out-of-pocket medical costs, as well as prescription drug plans, known as Medicare Part D.
Medicare Advantage is a health plan offered by private insurance companies as an alternative to original Medicare.
If chosen, it replaces and cancels original Medicare. It provides the benefits of Part A, B, and often D, usually for about the same cost, with lower copays. Some Medicare Advantage plans offer benefits not in Medicare, such as fitness classes or vision and dental care.
However, Medicare Advantage plans “can carry hidden risks, especially for people with major health issues,” Samuelson said.
“Some people in Medicare Advantage plans may end up paying unexpectedly high costs when they become ill or find that their network lacks the providers they need,” she said.
This often is true in rural communities.
Medicare allows people to see any provider who accepts Medicare. Most providers do.
Medicare Advantage plans usually require that care be from a limited network of providers. In most cases, pre-authorization from the insurance company is needed for many services.
A recent Kaiser Family Foundation study found that about half of Medicare Advantage enrollees end up paying more than people enrolled in Medicare for a seven-day hospital stay.
Another study found that rural residents with Medicare Advantage were nearly twice as likely to switch back to Medicare as those in urban areas.
Networks of providers in rural areas are especially small, making it harder for people to get care.
An increasing number of Kansas hospitals no longer accept Medicare Advantage plans, Samuelson said.
Hillsboro Community Hospital accepts all Medicare Advantage plans.
St. Luke Hospital accepts the four:
- Blue Cross Blue Shield Kansas Medicare.
- Humana Choice HMO/PPO.
- United Health care AARP/Secure Horizons Medicare Complete.
- United Health care Medicare Solutions.
Nearly all Medicare Advantage plans require approvals and authorizations before care can be given.
A 2022 American Medical Association survey concluded that 94% of physicians polled said authorizations delayed medical care. Kaiser Family Foundation reported that two million authorizations and approvals were denied in 2021 by Medicare Advantage plans.
The only way to learn about a Medicare Advantage plans’ approval and authorization practices is to ask your physician and hospital, Samuelson said.