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Choose Carefully During Medicare Open Enrollment

This article is the first of a series designed to highlight the pros and cons of Medicare Advantage plans. The Author is a former hospital administrator who spent over ten years as Executive Director of a statewide industry group dedicated to home health & hospice prior to becoming an Administrator for a home health agency. The views expressed here are intended to be factual, but I will give you my honest opinion as well.

 

 

Choose Carefully During Medicare Open Enrollment

– Todd Stallings, FACHE

Medicare-eligible individuals have from October 15th through December 7th to either choose traditional Medicare or a Medicare Advantage plan. If you already have Medicare Advantage, you can switch to a different plan for the upcoming year—or go back to original Medicare.

 

Whether to keep traditional Medicare or the try a Medicare Advantage plan is a complicated decision. It may be that complexity that drives consumers to give up and make the simple choice. If a helpful insurance agent is offering a Senior a simple fix and tells them the price is “free”, the Senior will often go along. A lot can be a stake, however, and like other aspects of life, the easy route does not always take you to a good place. Remember, Medicare Advantage is Managed Care.

 

Medicare Part A covers hospital care, skilled nursing in facilities, and home healthcare (partial list). Medicare Part B covers physicians’ care, along with other outpatient services. Notice that neither of these cover prescriptions, which can be covered by Part D (for Drugs). Parts A & B have copays and deductibles which can be covered out of pocket or with a good Medicare “Gap” or Supplement plan. Medicare Advantage (AKA Part C) rushes in to rescue consumers with a simple package that covers AB&D wrapped in one. Medicare is actually paying the Advantage Plan the premiums the Senior pays out of their Social Security payments and sometimes much more than that. For the cheapest plans, this covers the Plan’s premium, so it is referred to as “free.” Some deluxe Advantage plans charge an additional amount for better coverage.

 


Clear as mud, right?

 

While it is tempting to cut through the complexity with a seemingly “free” plan there are a few details that are not often considered when first electing to switch to Medicare Advantage. The first detail is that of limited choice. Medicare Advantage is Managed Care. Traditional Medicare covers you with any provider who participates with Medicare, which is most providers. When you sign up for Medicare Advantage, you agree to only go to the providers who have signed the insurance company’s contract and accepted the insurer’s deeply discounted rates.

 

Second, Medicare Advantage is Managed Care, so your treatments are not up to your Doctor alone. Nearly every admission, home health visit, medication, etc. that your Doctor orders are scrutinized by insurance company staff whose job it is to limit claims. This often does lead to delays in receiving care. Unfortunately, this often results in essential, medically necessary services being denied. Often these denials are inappropriate, as a 2018 report by the Office of Inspector General (OIG) found. The OIG reported that the Insurers have a financial incentive to deny care and that most appeals by providers eventually were successful.

 

Medicare Advantage plans are a great deal when you are healthy. However, they can often still have deductibles, copays, and coinsurance. So, while the plans are claimed to be “free”, they are not free of all costs. Often persons on Medicare Advantage plans seek to go back to traditional Medicare after they have been ill, as reported by the Government Accountability Office (GAO). Remember: Medicare Advantage is Managed Care.

 

Switching back to traditional Medicare can be a problem, so make sure you really want to deal with all that comes with a Medicare Advantage plan. As I stated earlier, you can switch to traditional Medicare during the Open Enrollment (through December 7th. However, Medicare Supplement / Gap plans do not have to accept you when you come off an Advantage plan. You will likely have to go through underwriting and if you have been very ill, you may not qualify.

 

Resources:

Differences between Original Medicare and Medicare Advantage
Medicare Rights Center

Unhappy With Your Medicare Advantage Plan? It’s Not Too Late to Switch ConsumerReports.com

Medicare Advantage Plans Found to Improperly Deny Many Claims
NYTimes.com

Medicare vs. Medicare Advantage: Ill Health Often Leads to Plan Switch
Kiplingers.com

The Hidden Costs In Medicare Advantage Plans
Forbes.com

 


If you or an aging loved-one are considering
 Home Care in Indianapolis, IN, please call the caring staff at Home Services Unlimited. Serving Greater Indianapolis Area. Call for Immediate Info & Assistance: (317) 471-0760

Etelka Froymovich, RN, MHA

Owner & Founder at Home Services Unlimited
Etelka Froymovich founded Home Services Unlimited in 1997
As a practicing Registered Nurse, Etelka was keenly aware of a void in quality patient care that could be provided in the home. She embarked upon a journey to develop a home health care agency that would exceed all expectations and become a trusted partner to physicians and patients.

A Distinguished Career From Nurse to Director of Nursing to President of Home Services Unlimited

Etelka’s distinguished career followed a logical progression to her position as President of Home Services Unlimited. She graduated as a nurse practitioner with a Bachelor of Nursing (RN) in 1972 from Meshgorya University in the Ukraine, close to where she lived with her family. She married her husband Phil in 1973 and decided in 1977 that they would relocate to the United States to be closer to family and to come to this land of opportunity. With an eagerness to continue her budding career, Etelka sat for and passed her Boards in the U.S. in 1979.

A Love and Talent for Working with the Elderly

Etelka began her nursing career in the U.S. at Colonial Crest, now part of Golden Living, where she was the In-service Coordinator, the Director of Training and Education and Director of Nursing, a position she occupied for several years.

With a group of partners, she co-founded Adept Corporation, which operated group homes for the mentally challenged. The business was successful and in 1996, Etelka sold her share to return to her roots, caring for the elderly.

In January of 1997, Etelka opened Home Services Unlimited as a fully licensed business to provide home health care. In her quest to learn to do better for her patients, she had already obtained a Masters in Healthcare Administration (MHA) in May of 1990 from the College of St. Francis. As President of Home Services Unlimited, Inc., Etelka guides the trusted, experienced care model Home Services Unlimited uses to continue providing excellent home health care.

Giving Back to the Community of Indianapolis

Volunteering for community services is a high priority for Etelka. Her memberships include the Indiana Association of Rehabilitation Facilities, Executive Women in Health Care and the Indiana Association for Home and Hospice Care, where she is a member of the Board of Directors.

Etelka has also served on the Board of Directors with Hooverwood Home, a highly regarded geriatric facility, since 1997 and as the President for 2005-2006. Through her community work, she has received several awards and accolades, including the Nora McFarland award in 2002, from the Indiana Association of Home and Hospice Care.

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