ISSUE 127 / 2020
Decisions Critical to Your Health
Signing up for Medicare is more like rocket science than you think. It’s critical to understand what you are getting. With so many choices, patients enroll and often have no idea of their benefits.
Most people with traditional Medicare also buy a supplement. Medicare Part B pays 80% of your bill and the supplement pays the additional 20%.
Traditional Medicare Card
Part A & B
With a Medicare Advantage plan, benefits are different. Advantage plans are overseen by insurance companies like Humana, Blue Cross or United Health Care, who take your money and “manage” it. In our opinion, the advantage is usually for the insurance company. Even if an advantage plan is your best option, it’s important to understand differences.
Medicare Advantage Card
- Supplement premium vs. copays: The enticement of Medicare Advantage Plans is the no or low monthly premium. Instead, you pay a co pay for each medical service. Here’s an example of how monthly costs may differ:
Mary’s Monthly Medical Expenses Supplemental Prem. $115.00 4 PT Visits 0.00 Total per Month $115.00
Rex’s Monthly Medical Expenses Advantage Plan Prem. $ 23.00 4 PT Visits – $40 CP ea. 160.00 Total this Month $183.00
As you can see in this example, Mary actually spent less for her supplemental insurance than Rex. Your case may be different. If you rarely visit a doctor or any other medical practitioner, an advantage plan might be fine. If you have regular doctor visits or other medical care, do the math and figure out which is best for you.
- Limits on which provider you can see vs seeing any Medicare provider. Most advantage plans have a network of practitioners. Before you sign up for an advantage plan, check to make sure you can still see the providers you prefer. If coming to ALTA is important to you, make sure we are in your advantage plan network before you sign up.
Regular Medicare allows you to see any practitioner who participates and that’s a much bigger group of providers.
- Visit limits vs medical necessity. Advantage plans have limits on care. Despite the promise that you will receive the care you need; we are seeing huge increases in authorizations and denials. We have also seen scenarios where authorizations are approved in 2 visits increments, which might delay or limit treatment.
|With regular Medicare, treatment is based on medical necessity. If your therapist and your doctor document the need for treatment, and you continue to improve with PT, it is generally covered.
Private insurances are advertising Medicare Advantage Plans, and they sound wonderful. A word of advice: check the fine print.
Open enrollment is October 15 – December 7. Now is the time to consider your options and make a plan. As always, we are happy to answer questions.
Last Chance to Make a Difference We flooded Capitol Hill with over 54,000 letters.
Now it’s time to raise our voices with Medicare to stop the 9% cut in payments for PT. It takes just a minute to submit your comments – deadline is October 5th. Do It Now!!