We are sure you’ve heard the old saying, “If it sounds too good to be true, it probably is.” Unfortunately, when it comes to selecting a Medicare Advantage (MA) plan over a traditional Medicare plan, this cliche might as well be the headline.
From everything you’ve seen and read, MA might seem appealing with its lower monthly premiums and all-inclusive prescription drug coverage.
And, while Faith Community Health System (FCHS) accepts all Medicare plans, there are many reasonsresidents of Jacksboro, Graham, Alvord, Bowie and surrounding communities should be very skeptical when it comes to Medicare Advantage.
Choosing an MA plan can significantly restrict your access to healthcare
But Easy is always easier, right? WRONG!
Unlike traditional Medicare, which allows you to see almost any doctor anywhere in the country, MA plans limit your choice of doctors and hospitals to those within its network.
This means MA network restrictions may impact your ability to receive care while traveling. For example, if you are on vacation or visiting grandchildren, available healthcare facilities may not accept your MA coverage.
Ka-ching! Huge out-of-pocket bills!
Prior Authorization & Coverage Denials
The biggest challenge associated with MA has to do with prior authorization and denial of coverage in far too many situations.
What could this mean for you?
Let’s say you visit your doctor and he or she decides you need a particular test, medication, procedure or other type of care. (This happens every time you see the doctor, right?)
Prior Authorization means your doctor has to send a request to Medicare Advantage to get permission to provide you with the care you need. A staggering 99 percent of Medicare Advantage plans require prior authorization for services covered by traditional Medicare, such as skilled nursing, short-term hospital stays and durable medical equipment.
Without approval and prior authorization from MA, your care won’t be paid for by your insurance plan.
And who exactly makes these important decisions at the insurance company? Often, it’s administrative staff; they most likely are not physicians and may not have any medical training at all.
Each Medicare Advantage plan uses its own guidelines for making coverage decisions, which differ from those used by traditional Medicare. As a result, Medicare Advantage plans tend to deny coverage more often than traditional Medicare, including for services that traditional Medicare would cover.
Don’t Take Medicare Advantage’s Word for It
MA plans are not a substitute for traditional Medicare. No matter how great the plan sounds on the TV or radio commercial, this is absolutely a “Buyer Beware” situation. Protect yourself!
Before choosing a Medicare Advantage plan, have a conversation with your doctor to ensure you understand all the facts and how having an MA insurance plan might impact your ability to get the care you need close to home.
Faith’s rural health clinics, Faith Community Hospital and the freestanding ER in Bowie welcome all patients. Visit www.fchtexas.com to learn more about our facilities and services.