• Residents should carefully compare the privately-run versions of the government’s Medicare before choosing.

Residents eligible for Medicare have already been inundated with marketing and advertising about Medicare Advantage plans. That’s because the open enrollment period for Medicare for seniors began in October and runs through December 7.

The marketing effort pushing the Medicare Advantage plans shows the plans are adding some benefits not typically covered by Medicare. But, those added benefits should be carefully considered since some Medicare Advantage plans, which are privately run versions of the government’s Medicare, can restrict access to a network of doctors or hospitals, cause delays in procedures and limit care, as was recently reported in the Star Tribune. Traditional Medicare doesn’t do that.

Only about one-third of the people on Medicare opt for a Medicare Advantage plan, according to the nonprofit Kaiser Family Foundation. There may be confusion about whether or not to sign up for the traditional Medicare plan or a Medicare Advantage plan. And there are some pitfalls that many Medicare Advantage enrollees don’t find out about (the limitations of their Medicare Advantage plans) until they get sick, according to a recent report on Investopedia. 

Some, who were dissatisfied with the Medicare Advantage plan they signed up for last year, can use this open enrollment to switch plans or opt for the traditional Medicare plans.

And, those who sign up for a Medicare Advantage plan during that open enrollment period, but later regret their choice, can make one change in the first three months of the year. The second window applies only to those who already signed up for a Medicare Advantage plan, it was stated on the medicare.gov website.

Pitfalls of Medicare Advantage Plans

By Lita Epstein, Investopedia.com

Medicare Advantage, also referred to as Medicare Part C, plans may sound enticing. As one plan, it combines Medicare Parts A and B benefits and may cover prescription (D) and other benefits. Many offer $0 premiums, but the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick and only want you as a customer when you’re healthy.

Also known as Part C, these plans, which private insurers provide as an alternative to traditional Medicare, must provide the coverage required by Medicare at the same overall cost level. However, what they pay can differ depending upon your overall health.

Coverage Choices When 

You Qualify for Medicare

When choosing medical coverage as a senior citizen 65 years old and over, you can make one of three choices:

• Traditional Medicare, which has co-pays and deductibles.

• Traditional Medicare with Medigap private supplemental policy) that covers Medicare’s co-pays and deductibles.

• Medicare Advantage, private insurance that varies greatly depending on the policy you choose.

Key Takeaways…

• A Medicare Advantage (MA) plan, known as Medicare Part C, provides all of Part A and B benefits and sometimes Part D (prescription) and other benefits.

• All Medicare Advantage providers must accept Medicare-eligible enrollees.

• Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to co-pays and out-of-pocket expenses.

• Medicare Advantage customers can switch back to Traditional Medicare once per year during the annual enrollment period.

• Prospective Medicare Advantage customers benefit from researching plans, reviewing co-pays, out-of-pocket costs, and eligible providers.

Most Comprehensive Coverage

 The most comprehensive coverage, which will likely result in the fewest unexpected out-of-pocket expenses, is a traditional Medicare plan paired with a Medigap policy. Medigap policies vary, and the most comprehensive coverage is offered through Medigap Type F. With Medigap Type F, all co-pays and deductibles are covered, and you even get some coverage when you travel outside the country. With this combination, you can go to any doctor who accepts Medicare. Be aware that with traditional Medicare and Medigap, you will also need part D prescription drug coverage.

The Devil Is in the Details

Medicare Advantage plans do not offer this level of choice. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage plans can’t cherry-pick their customers (they must accept any Medicare-eligible enrollee), they discourage people who are sick by the way they structure their co-pays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick:

“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.’”

You can see how a Medicare Advantage Plan cherry-picks its patients by carefully reviewing the co-pays in the summary of benefits for every plan you are considering. To give you an example of the types of co-pays you may find, here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

•Ambulance – $300

•Hospital stay – $175 per day for first 10 days

•Diabetes supplies – up to 20% co-pay

•Diagnostic radiology – up to $125 co-pay

•Lab Services – up to $100 co-pay

•Outpatient x-rays – up to $100 co-pay

•Therapeutic radiology – $35 or up to 20% co-pay depending on the service

•Renal dialysis – 20% of the cost