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Know Before You Enroll

Medicare Open Enrollment

Medicare Open Enrollment for 2019 runs October 15th through December 7th.  This is the time when many beneficiaries review their current Medicare plan coverage and explore options for the upcoming year.  We understand the options are many, and the answers are few.  While we cannot endorse any products or plans, we do offer these tips: 

1.  There is a difference!

There is a difference between a Medicare plan with a supplemental and a Medicare Advantage plan.  Some salespeople may indicate there is not a difference.  From a facility perspective, I must inform you that there is a difference.  Medicare Advantage plans are paid by Medicare to cover the beneficiaries who choose their plans.  They may have different rules, such as requiring pre-approval (authorizations) for services that traditional Medicare automatically covers.  They may also have higher copayments or deductibles than Medicare, especially if you are out of network for services.  Plan designs may be different, so I caution you to be careful.  Skilled nursing or home health benefits, for example, may not be covered the same way by a Medicare Advantage plan.  Always read the details!

2.  Plans change from year to year.

The plans can and do change from year to year.  For example, vision coverage may be included in your plan this year but removed next year.  A benefit, such as skilled nursing, may also change, say from 30 days this year to 10 next year.  Deductibles and coinsurance are subject to change as well. Again, be careful as you select your plan, and read the details. 

3.  Know if your providers are contracted with your insurer.

Know if your providers are contracted with your insurer.  Not every physician, hospital, or service provider is contracted with every insurer.  Sampson Regional Medical Center, for example, currently has one signed Medicare Advantage contract.  We do not believe it’s right for aninsurance company to sell a product in a county where the hospital is not contracted.  It puts the hospital in a position to bill the beneficiary for services provided, or in many cases, not be paid for the service at all.  It will force Sampson Regional to deny non-emergency services for Medicare Advantage beneficiaries, which we have never had to do before.  

Sampson Regional Medical Center currently has a signed Medicare Advantage plan with Blue Medicare and Aetna.  We cannot contract with insurance companies that offer to pay less than what traditional Medicare will pay.  As such, we are not likely to agree in terms with United Healthcare (which is different than the AARP supplemental insurance plan) for their Medicare Advantage plan.  We are in active discussions with Gateway for their Medicare Advantage plan but cannot guarantee at this point we will agree in terms by time of open enrollment.  We currently do not have any contracts with Humana, nor are we in discussion with them. 

Be careful in making plan changes.  The rules are different between Medicare Advantage plans and traditional Medicare.  If you move to a Medicare Advantage plan, you can always get your Medicare plan again, but you will not be guaranteed that you can pick up your secondary insurance plan again.  Additional help is available through Medicare by calling 1-800-633-4227 or online at www.medicare.gov