Understanding Medicare plans
Deciding which Medicare plan best fits your needs is one of the most important health care decisions you will make. Medicare coverage can be complicated, and choosing the right plan makes all the difference in quality and cost of care.
Each year, Medicare beneficiaries have an opportunity to make changes in their Medicare coverage during the period known as “open enrollment,” which runs from October 15 through December 7.
Learn the differences in Medicare coverage so you can make an informed decision.
Medicare Part A covers care received in facilities such as a hospital or skilled nursing facility.
Medicare Part B covers outpatient services such as physician visits, lab work and outpatient skilled therapy. The premiums you pay for Medicare Part B are typically deducted from your Social Security benefit.
Medicare Part D is prescription drug coverage.
Medigap plans are optional supplemental insurance coverage that help cover out-of-pocket costs not covered by Medicare, such as coinsurance costs and copayments. These costs can be substantial, so it’s a good idea to have a Medigap plan in place.
Traditional Medicare/Medigap coverage allows flexibility to choose your primary care provider, see specialists and choose which facility you want to use for hospital and post-hospital rehabilitation.
Medicare Advantage Plans, or managed care plans, also known as Medicare Part C, are an alternative to traditional Medicare and take the place of your original Medicare coverage. Medicare Advantage Plans are required to cover everything original Medicare does. Many managed care plans also offer coverage for services that traditional Medicare doesn’t cover, such as dental, vision, prescription drug coverage, transportation and more.
Medicare Advantage Plans and traditional Medicare/Medigap coverage are not the same.
MEDICARE ADVANTAGE PLANS:
- Often offer very low premiums – sometimes as low as $0 per month. It is an unpleasant surprise to find your Medicare plan unexpectedly won’t cover certain expenses when you get sick, resulting in unforeseen out-of-pocket costs for you.
- Have strict provider and facility networks (often with no out of network benefit coverage).
- Require pre-authorization for care, including “skilled care” at a nursing facility after a qualifying hospital stay. If the Advantage Plan administrators decide a treatment or service is not medically necessary, they will deny coverage.
- Advantage Plan administrators determine the length of stay for a patient based on information sent from the facility.
- Advantage Plans do offer appeal rights if you disagree with the decision regarding admission or discharge. Filing an appeal can be challenging – especially in a stressful time of illness.
- Medicare Advantage policies are offered by a number of health insurers. These plans are not standardized, which makes comparisons with other plans difficult.
- Although Medicare Advantage Plans do have several upsides, the downside of these plans can be very impactful as well. Some things to consider when deciding whether or not to choose a Medicare Advantage Plan:
- Read the fine print. Get a comprehensive list of all co-pays and deductibles that you will be responsible to pay.
- Make sure all of your medications will be covered.
- Check to see if your doctors accept the plan.
- If you discover your current physicians do not accept the Advantage Plan, be sure the physicians that are “in-network” with the plan are acceptable to you and they are taking new patients covered by the plan.
- Ask if your preferred local hospital is “in network.”
- Ask if nursing facilities where you would want to complete a post-hospital (skilled) stay are covered by the plan.
- It is important to remember that even though Kidron Bethel Village or Schowalter Villa are “in network” with a plan, the decision to authorize a skilled stay is always made by the Medicare Advantage Plan.
Kidron Bethel Village is in network with the following Medicare Advantage Plans:
- Coventry (Aetna)
- Blue Cross Blue Shield
Schowalter Villa is in network with the following Medicare Advantage Plans:
- Coventry (Aetna)
- Blue Cross Blue Shield
If you would like assistance navigating Medicare plans and options, you can use a Senior Health Insurance Counseling for Kansas (SHICK) agent. SHICK agents for Harvey County, Kansas, can be contacted through Sedgwick County Extension Services, 316-660-0100, extension 0117, or Central Plains Area Agency on Aging, 316-660-5132. To find Medicare plan information or compare plans, go to medicare.gov or call 1-800-633-4227. TTY users can call 1-877-486-2048.