The Medicare Challenge
In the U.S., 55.8 million people 65 years of age and older make a Medicare choice each year.
They make critical Medicare plan decisions which determine their access to their healthcare providers. They make this selection primarily using information and celebrity endorsements of Medicare Advantage plans.
Access
Medicare Advantage plans do not provide easy access for seniors with conditions that require many doctor and hospital visits or surgical procedures. Medicare Advantage plans require many approvals that can delay services and sometimes they deny these approvals.
Premium Costs
Medicare Advantage Plans advertise that they pay 100% not the 80% that Original Medicare covers. With Medigap insurance in Original Medicare, 100% is covered. Medigap insurance makes up for that 20% gap in coverage at affordable rates.
Drug Coverage
Another key fact not fully represented in Medicare Advantage ads is drug coverage. Seniors must find out if their brand name drugs and mail order drugs are covered.
Provider Networks
Because of the lengthy approval processes and denials and reimbursement rates lower than Original Medicare, many hospitals, clinics and physician practices have stopped accepting Medicare Advantage Plans.
The Right Choice for Patients
If a senior is healthy and doesn’t require a lot of medical services nor take expensive brand name prescriptions then these plans could save them money. Seniors with chronic conditions like heart disease, diabetes, cancer or other serious conditions will be frustrated with Medicare Advantage Plans because of the approval processes, often delaying care and sometimes denying services. Delays and denials can cause detrimental health repercussions.
Information and Guidance
Navigating the Medicare Plan complexities is difficult. However, TCI has powerful communication tools that cover these complex topics in simple, understandable language.
Role of Clinicians in Providing Guidance
One of the tools that is provided in the Medicare Tool Kit is an easy presentation that gives the most critical facts seniors need to know in making their healthcare decisions.
