October 15th-December 7th
Submitted by Briana Snyder, Options Counselor
With the Medicare open enrollment period beginning on October 15, we encourage Medicare beneficiaries to choose carefully between traditional Medicare and joining a private Medicare Advantage plan. This is particularly important, as consumer marketing protections have been reduced and public promotions of Medicare Advantage are increasing – including on TV and in the mail. Here are some pros and cons regarding traditional Medicare and Medicare Advantage to consider:
Traditional Medicare allows access to all doctors, health care providers, hospitals and facilities that accept Medicare nation-wide.
• All people in traditional Medicare have access to similar benefits, which are available to them wherever they are around the country
• People in traditional Medicare usually do not require prior authorization to see specialists
• People with traditional Medicare can choose whatever Medicare prescription drug plan best serves their needs
• People with traditional Medicare often have better access to home health care, nursing homes, and rehabilitation
• People with traditional Medicare often need to purchase a “Medigap” policy to pay for Medicare cost-sharing.
• Lower-income people can get help paying for Medicare cost-sharing
Medicare Advantage plans are private plans, like HMOs. They usually limit your choice of doctors, health care providers, hospitals, and facilities to a “network” of certain providers within your local geographic area. (Unless the needed care is an emergency or “urgent.”)
•Medicare Advantage plans can cut doctors and other health care providers from the plan network during the year
•Medicare Advantage requires “prior authorization” from the MA plan for many health care services
•Medicare Advantage often includes a prescription drug plan and some additional “supplemental” benefits such as help with dental care, gym memberships, and other benefits for some participants
•Medicare Advantage cost-sharing can be less than traditional Medicare, and MA plans are required to have a cap on out-of-pocket expenses. However, they also sometimes include co-pays not in traditional Medicare (for example – for home health care).
•Lower-income people can get help paying for Medicare cost-sharing
*Information from Centers for Medicare Advocacy
For further information please reach out to Briana Snyder, Options Counselor (716) 945-8991.
