Turning 65 brings a big decision: Should you go with Traditional Medicare or Medicare Advantage? If you are already a Medicare Advantage recipient and you are frustrated with lengthy prior authorization waiting periods and getting necessary care turned down leaving you holding the bill, keep reading…
You watch and hear the commercials on TV and radio. You may even read about the differences between the two Medicare plans in publications such as those put out by the AARP. All the hype makes it sound like Medicare Advantage is so much easier and so much cheaper for you.
But if we Texans know anything it’s that “if something seems too good to be true, it most certainly is!” And, this is the case with Medicare Advantage. It sounds less expensive. It sounds like you get all the bells and whistles that come with insurance – without the extra hassle of referrals, etc.
It’s simply not true. Often Medicare Advantage puts patients at a serious disadvantage when it comes to getting the healthcare they need. Since it’s impossible to know what the future will bring, it’s important to think about the possible healthcare needs you might have as you age.
For example:
No one plans to have a bad fall, right? But if you do take a tumble, you may very well need durable medical equipment (such as a wheelchair or walker), rehabilitation and physical therapy.
Did you know that with Medicare Advantage, your doctor will have to obtain “prior authorization” for you to get the care you need? Often, Medicare Advantage says “no!” And the decisions are not even being made by doctors; most often they are made by administrative people.
Get the Facts Before Choosing Medicare Advantage Over Traditional Medicare!
Having all the info you need to make an informed choice is key to finding the best health care coverage for you.
In some areas of the country, patients have a significant challenge finding healthcare providers who accept Medicare Advantage.This means if you are traveling and need care, you may have to hunt down a facility and practitioner willing to accept your Medicare Advantage. Fewer than half of the doctors in the U.S. work with any Medicare Advantage plan.
Closer to home, at Faith Community Health Services, all our physicians DO ACCEPT Medicare Advantage. However – and this is critically important – any care your Faith physician wants to recommend for you will have to get pre-approved by Medicare Advantage. That could mean a long wait and possible refusal to pay for services. Where does that leave you?
With Traditional Medicare, your doctor is fully in charge of your care. If you need tests, medication, procedures or equipment, you’ll have it in a timely manner.
Plus, Traditional Medicare is accepted by almost every hospital and doctor across the country, offering broad access to care. Go ahead – visit the grandchildren with peace of mind!
Here are Your Best Options Moving Forward…
- New to Medicare? You have seven months to initially select your Medicare plan. Three months before you turn 65, your Initial Medicare Enrollment Period begins. Your initial open enrollment period ends three months after the month you turn 65.
During this seven-month period, you will have the option to choose from various Medicare offerings. Again, buyer beware! Make sure to opt for Traditional Medicare so no one other than you and your healthcare providers can make decisions about the care you receive.
- Already a Medicare subscriber? The open enrollment period for Medicare plans for 2024 will run from Oct. 15, 2024 to Dec. 7, 2024, with changes taking effect on Jan. 1, 2025. During this time, people with Medicare should compare coverage options and choose health and drug plans for the year. This is the time to make a change from Medicare Advantage to Traditional Medicare. Mark your calendars!
- Qualifying Life Event: If you currently have Medicare Advantage and experience a change in your situation — also known as a “Qualifying Life Event,” such as getting married or divorced, having a baby or losing health coverage — you automatically become eligible for a Special Enrollment Period.
This is a time, outside of the usual Medicare Enrollment period in the fall (see No. 2 above), when you can opt out of Medicare Advantage in favor of Traditional Medicare.
Traditional Medicare gives people, like you, the freedom to keep their doctor or choose a new one that fits their needs. Moreover, it puts decision-making about your health in your trusted doctor’s hands.