By Frank L. Beaman, CEO, Faith Community Health System
Before we know it, our mailboxes, television screens, newspapers, social media feeds and radio broadcasts will be filled with advertisements about Medicare Open Enrollment. You have the option of a Traditional Medicare plan or what we at Faith Community Health System call a Medicare ‘Dis’ Advantage plan.
Not unlike the rest of our great country, our community is aging and more people are eligible for Medicare than ever before. This message is for you whether you are signing up for Medicare this year for the first time, or whether you already receive Medicare healthcare coverage and are considering a change.
Thanks to the advertisements I just mentioned, there is a growing number of seniors who are being lured into choosing Medicare Advantage plans over Traditional Medicare. Why? Simply put – the ads talk about the advantages of Medicare Advantage. And, why not? After all, ads are marketing tools designed to get you to make the decisions that big companies, including national insurance companies, want you to make. One thing is for certain: Big Insurance is looking to line its own pockets. They are focused on their own bottom lines – not on customers’ wallets. And, they certainly have little or no ties to our local community.
Why am I telling you this? Because at Faith, we believe Medicare Advantage puts patients at a disadvantage almost always and it’s causing some real financial problems for our hospital system and for Faith’s healthcare professionals who work tirelessly to care for you and your families.
I realize, and respect, that the choice between Medicare Advantage and Traditional Medicare is a personal decision. We want every senior in our community to have the coverage that works best for them. However, from Faith’s perspective, Medicare Advantage offers little to no advantage for you or our healthcare system.
The Big Issue: Medicare Advantage Plans Limit, Delay and Deny Care
Medicare Advantage plans are designed to keep costs down, but the way they do it is by limiting the care they pay for. Sometimes, the limits are right there in the plan documents. For example, a plan might say it only covers 15 home health visits or 30 physical therapy sessions. But even getting those benefits is complicated.
Even if your plan says it’ll cover 15 visits, your doctor still has to jump through hoops to get approval. They have to prove why the care is necessary and explain everything to someone who doesn’t know you or your medical history.
That person (usually not even a medical professional!) gets to decide whether to approve or deny the request, and this can take days. And here’s the kicker: they might deny it without ever talking to you or even suggest a different treatment than what your doctor recommended. Every plan has its own rules for how they make these decisions.
For Faith’s doctors and nurses who are here around the clock, this process adds a ton of extra work. Instead of focusing on patient care, they’re stuck dealing with paperwork and delays. This not only stresses them out but also takes them away from where they’re needed most—caring for you and the rest of our community.
Limited Local Care and Added Burdens
Another big problem is that Medicare Advantage plans often don’t have networks of local healthcare providers. This means that when our providers need to refer you for specialized care or post-hospital treatment, they might have to send you far away, sometimes to the nearest big city.
These trips can really add up, especially for seniors who don’t have reliable transportation or someone to help them get there. In some cases, people might end up skipping the care they need altogether.
Further, if you need to travel away from home – let’s say to visit your grandchildren or take a much-deserved vacation – and you need healthcare, you may not be easily able to find a facility or practitioner who accepts Medicare Advantage. That leaves you to forego care or pay out of pocket. Ka-ching!
Financial Strain on Faith
Here’s the truth: Medicare Advantage plans don’t pay Faith Community Health System the full cost of the care we provide. While the exact rates are kept secret, studies show that these plans pay about one-third less than Traditional Medicare for the same services. This means that every time we treat someone with a Medicare Advantage plan, Faith is essentially losing money.
Now, it may seem rather self-serving for me to be sharing this information with you. But healthcare professionals don’t want to work for free. And, they don’t have to – they can leave our community and be significantly better compensated. They practice here because they are committed to providing residents of rural communities with the highest quality healthcare.
The Bottom Line
When you start getting bombarded in the coming months with all those advertisements that make Medicare Advantage sound so great, I really want you to remember the old adage: “If it sounds too good to be true, it usually is too good to be true.”
The only ones who benefit when senior citizens choose Medicare Advantage are the insurance companies. And the insurance companies don’t care about you personally.
Faith Community Health System, on the other hand, is here for you and your family. It stands to reason, however, that if rural health systems cannot pay doctors and nurses well, they won’t keep practicing medicine here.
This is really about making sure you and your neighbors have access to the very best healthcare. As you decide which Medicare plan to sign up for during open enrollment this year, please put yourself and Faith first. Believe me, the insurance companies want your money – but they’ll do just as well without your support. Unfortunately, I cannot say the same about Faith Community Health System.
Please visit www.FCHTexas.com to learn more about Faith’s four rural health clinics in Jacksboro, Graham, Bowie and Alvord, Jacksboro Hospital, the Freestanding Bowie ER and the Swan Family Wellness Center.