Although we are just beginning to enjoy summer in New England, the staff in the CHOICES health insurance counseling program are preparing materials for Medicare open enrollment which will begin in October.
During Medicare Open-Enrollment, each Medicare beneficiary must decide whether to utilize Medicare in its original format or to join a Medicare Advantage Plan. There are pros and cons with each option. What is important to remember is to determine what the best option is for your set of circumstances.
When considering an Advantage plan there are multiple plans to choose from so it’s important to review all the available information about competing plans and not just the advertising materials produced by the plans. One factor to review is the plans’ rate of denial for services ordered by your health care team. A study by the US Office of the Inspector General revealed that for some plans the denial rate for long term care services such as rehabilitation hospital care and skilled nursing home care was exceedingly high. One major plan denied care 80% of the time and another 72%. The rate of these decisions being overturned on review was nearly 100%. But it took days and even weeks before the decision to overturn was made, leaving the person needing care in a precarious situation.
The report also determined that denial rate was highest in advantage plans that were sold by for-profit organizations. One of the factors that influence individuals to opt for the Advantage plans is the low cost or even no cost premium, whereas insurance policies that work with original Medicare to cover the balance of cost for covered services are very costly and out of the reach for many older adults. Additionally, some Advantage plans offer additional benefits at no additional cost such as gym memberships or grocery gift cards. There are many factors in determining whether to remain with original Medicare or join an Advantage plan and which Advantage plan is right for you. Failing to consider all the pros and cons can result in making a decision you might regret later. So, while you’re sitting outside and enjoying the summer think about your health status, how frequently you use your Medicare benefits, whether your healthcare provider accepts all Medicare plans, whether you’re considering surgery this year for your eyes, or knees or hips.
Explore your options. If your decision about Medicare is limited by your ability to afford an additional insurance to supplement Medicare, determine whether you are one of the 68% of people who are eligible for the Medicare Savings Program that pays for Medicare premiums, co-pays and deductibles and aren’t enrolled yet.
For more information about Medicare and the Medicare Savings Program, call CHOICES at the Agency on Aging 1-800 994-9422.