With Medicare Open enrollment beginning on October 15th, many seniors have tough decisions to make in choosing their healthcare plans. Medicare Advantage plans, often called Medicare replacement plans have become a very popular choice among seniors. I would strongly urge any senior to thoroughly exam all aspects of the Medicare Advantage plans and compare with the traditional Medicare plan offered by the government as there are very distinct differences which will affect your healthcare coverage.
Medicare Advantage plans are offered by private healthcare companies such as Humana and United and they are generally HMO’s or PPO’s. These plans have become popular for several reasons. Medicare Advantage plans often bundle dental and vision which traditional Medicare plans do not cover. Under traditional Medicare plans, you have to enroll in Part D for medication coverage and there is no option for dental.
Advantage plans also tend to have lower co-pays and monthly premiums. All these are wonderful things. However, what seniors do not often understand is the lack of coverage in many areas. Once enrolled in a Medicare Advantage plan, you are limited to a list of their network providers. Currently, our healthcare system is saturated with seniors seeking care. Many caregivers out there and seniors are seeing how difficult it can be to find physician’s accepting Medicare. Once finding these physicians, they are often booked for months as there are simply not enough physicians accepting Medicare to support the current aging population. The same is true with limited availability at many senior healthcare facilities. One can see that any limitations on providers in an already saturated healthcare system would be problematic.
The Medicare Advantage plans also tend to have limited coverage for some outpatient therapy services, mental health services, and for skilled nursing and rehab. It is very common that seniors will need to stay in a skilled rehab facility post hospitalization for therapy prior to returning home. Such reasons for admittance to a rehab facility for recovery include pneumonia, post hip and knee replacement surgery, heart attack and congestive heart failure, stroke, and falls resulting in injury. For times when a slow recovery is likely, it would be detrimental to have limited skilled nursing and rehab coverage. With this being said, one should really examine all aspects of both plans beyond just the financial. Many in good health will find these plans to be very desirable. However, if your condition suddenly changes limited coverage could put you in a very bad situation. To learn more about difference on Medicare Advantage plans and traditional Medicare you can refer to Medicare.gov and the AARP website.
Laura Cayce is the Director of Care Management for CaraVita Home Care. She joined CaraVita Home Care in 2010 to manage and direct the company’s caregiving initiatives. She is an Alzheimer’s Association support group facilitator, and a member of the National Association of Social Workers, the National Association of Professional Geriatric Care Manager and the National Alzheimer’s Association.