News & Updates


Medicare Advantage plan deadline nears

03/17/2009 © Ft. Myers News-Press 

Insurance companies are making a last push to enroll people in Medicare Advantage plans, a privatized form of the nation?s health plan for seniors, before a March 31 deadline to change plans.

Meanwhile, negotiations between insurers and Lee Memorial Health System are showing progress ? good news for patients who are worried about the lack of formal contracts between their Medicare plans and the county?s dominant health provider.

People who qualify for Medicare have essentially two options for how their benefits are delivered: They can pay for traditional Medicare, which covers hospital stays and physician visits, along with buying a prescription drug plan and a supplemental policy to cover the costs Medicare doesn?t. Or, they can go through a private insurer and purchase an HMO-style plan that rolls hospital, physician, drug and supplemental coverage into one and may offer enhanced services such as wellness programs.

Medicare beneficiaries for the most part made their plan choices during the annual enrollment period last November and December. But there is an additional enrollment session running until March 31 during which seniors can change plans. If they opted for traditional Medicare, for example, they can switch into a Medicare Advantage plan or vice versa. The session allows seniors to exit a plan that is not working for them before they get locked in for the remainder of the calendar year.

Gaining acceptance

Medicare Advantage plans are gaining a foothold nationally about a fifth of the nation?s seniors now are enrolled in the plans, though the concentrations of enrollees vary from state to state and market to market. Their long-term future is unclear as President Obama has said he wants to trim the amount of money the government pays private companies to manage Medicare.

Medicare Advantage plans wrap hospital coverage, physician and outpatient care and prescription drug plans into one. They also may offer enhanced benefits such as annual check-ups and preventive services, and often carry a lower monthly premium.
But they also have rules and restrictions that seniors need to understand. Pam Anderson is the business manager at Internal Medicine Associates, a large primary care practice in Lee County. She said patients frequently don?t understand their policies, and that causes confusion when they get their bill. She offers the following advice:

  • Find out your plan?s deductible. Seniors need to understand their financial obligations and also what services count toward the deductible.
  • Find out your out-of-pocket expenses such as copayments. 
  • Find out if your doctor accepts the plan. Unlike traditional Medicare, which nearly all physicians accept, doctors can choose whether they want to do business with the Medicare Advantage plans. Doctors may also drop out of Medicare Advantage plan agreements, so make sure you know your doctor?s status.
  • Check your drug costs and understand your responsibilities under the plan.
  • Find out whether you can use your plan out-of-state. Like commercial insurance plans, Medicare Advantage plans have networks of local providers. That means snowbirds and travelers won?t get in-network rates for their copayments if they are seeking care outside the network. Traditional Medicare can be used anywhere and may be a better option for people who travel or have dual residences. Talk to a trusted agent or Medicare counselor.
  • Understand what kind of plan you have. There are many kinds of Medicare Advantage products, and the plan type does make a difference on whether you need a primary care doctor?s referral to specialists, or preauthorization on services or other matters.