With the exception of emergency or emergency care, Medicare Advantage coverage cannot extend outside the beneficiary’s county or state. “If you are in Albany, you may not be able to get treatment in New York City,” said Dr. Jacobson. Advantage plans also often require prior authorization from the insurer for services and medications.
With traditional Medicare, “you can see any provider anytime, without getting prior approval,” Dr. Jacobson said. It is accepted at the national level. But taking into account a private Medigap policy and a separate Part D plan sometimes increases the overall costs.
Yet a recent Commonwealth Fund analysis found that traditional health and benefit plans (excluding special needs plans) are now attracting similar populations in terms of demographics and health, with rates satisfaction levels high in both groups (although both said they waited more than a month for a doctor’s appointment).
According to the study, Advantage recipients are more likely to receive certain managed care services, such as a medication review. But when it comes to patient health, “that doesn’t seem to change the results much,” said Dr Jacobson, as hospitalization and emergency room use were roughly the same for both groups. .
This raises the question of whether the federal government should continue to pay Advantage plans 4 percent more per beneficiary than it pays for those under traditional Medicare. All those who pay a Part B premium, that is, almost all beneficiaries, end up subsidizing this higher cost.
But for now, it’s open registration season. SHIP programs in every state, with 12,500 trained team members, are the best source of unbiased information and work with over 2.5 million people each year.
Ms Korsah, who switched to traditional Medicare because she wants to be able to choose her doctors, signed up for the low-cost Wellcare Part D plan and will likely pay less for drugs than last year.
So she appreciated Dr Hoadley’s advice. “He was a big help,” she said.