#Medicare #MedicareAdvantagePlans #MedicarePartC #HealthCareNetworks
The ads are relentless this time of year, trying to get those on Medicare to sign up for Advantage plans, the so-called Medicare Part C.
These plans can indeed, in many cases, offer more benefits and lower costs.
But, if you want absolute – or as close to absolute as possible – freedom of choice in where you get your care, stick with the Medicare Part A, B and D plans.
These Part C plans, in most cases, are tied to a network of practitioners. In other words, you have to go to someone in that network to get your care covered by your insurance. In many cases, practitioners outside the network will not take you as a patient.
As a patient, you may develop a rare or complicated disease, even if you are relatively healthy today. Sometimes, going to see a specialist that is far from where you live would give you the best chance at recovery or survival. Chances are, that specialist won’t be in the network with which your Part C plan is affiliated. That may preclude you from the best care you can get.
Also, some of the Part C plans also require referral from a gatekeeper, usually a primary care doctor in the network, to see a specialist within the network.
Then, with Part C, there is the risk that large medical providers within the network will have battles with the insurer over reimbursements. When the practitioners hold the insurer hostage, or vice versa, the patients suffer and may lose their health care providers – temporarily or permanently.
These Part C plans are the more profitable products for the health insurers. Those who sell them earn much higher commissions. And, as we all see, they spend a fortune in advertising that might be better spent on patient care. Reports indicate that these plans actually cost the government more than regular Medicare.
All this isn’t to say that everyone should stay away from a Part C. plan. If you are someone who doesn’t often go far from home, and the practitioners you like are in the network, it could work for you. Be advised, however, that in many of these plans, the practitioners can come and go at will, while patients are locked in for the year.
If you do shop your Medicare plans, it might be best to find someone who sells multiple plans and could give you more choices. However, if want the flexibility that Part C plans do not give you, don’t let someone talk you into settling for a Part C plan. As of today, Parts A, B and D are still an option.
Medicare has been a marvelous way for retirees to get health insurance, usually with no questions asked. If you opt for a Part C plan, and it doesn’t work for you after a time, going back to Medicare parts A, B and D may be difficult, more expensive and may not cover pre-existing conditions.
Some of the ads for Medicare Part C often are created to make older people look stubborn, angry and, well, uniformed. Not everyone is like that. Or, others have celebrities doing everything they can to get you to call a certain number to examine plans.
But, it boils down to a simple decision: do you want flexibility in deciding where to get your care? If it doesn’t matter to you, then shop around for the best price, most convenient practitioners or whatever you are looking for.
If you get sick or injured on vacation, the practitioners you need where you are may not be in your network. Make sure you know what will happen to you, financially, if that occurs.
The hard sell for these Part C plans not only turns people off, it should be unnecessary.
Peter