The annual Medicare open enrollment period is scheduled to run from October 15 to December 7, allowing seniors to switch between Original Medicare and Medicare Advantage or change their prescription drug plan.
Original Medicare, managed by the federal government, consists of two parts: Part A (hospital insurance) and Part B (medical insurance). This traditional Medicare plan typically costs around $175 per month. Many individuals also purchase Medigap to cover copays and out-of-pocket costs, as well as a Part D plan for prescription drugs.
Medicare Advantage, offered by private insurance companies, provides an alternative to Original Medicare. It combines the benefits of Part A, B, and often D, usually at a similar cost, with lower copays, eliminating the need for Medigap. Some Medicare Advantage plans offer additional benefits, such as fitness classes, vision, and dental care.
However, choosing between Original Medicare and Medicare Advantage requires careful consideration of finances and health needs. Medicare Advantage plans can carry hidden risks, particularly for individuals with significant health issues, and may result in unexpectedly high costs or limited provider networks.
With Original Medicare, individuals can see any provider who accepts Medicare, whereas Medicare Advantage plans typically require care from a more limited network of providers, often necessitating pre-authorization for specialist visits, hospital stays, and various medical services.
A recent Kaiser study found that approximately half of Medicare Advantage enrollees would incur higher costs for a seven-day hospital stay compared to those with Original Medicare. Rural areas may be particularly affected, with narrower provider networks and higher rates of switching back to Original Medicare.
Several hospitals nationwide have opted not to accept Medicare Advantage plans due to concerns about patient care and unreliable payments. This trend is also observed in Missouri.
Nearly all Medicare Advantage plans require approvals and authorizations before care can be provided. A 2022 American Medical Association survey revealed that 94% of physicians reported delays in medical care due to authorization requirements. In 2021, Medicare Advantage plans denied approximately two million requested authorizations.
Missourians can learn more about Medicare Advantage plans’ approval and authorization practices by consulting with physicians and hospital providers. Original Medicare information is at this link and Information on Medicare Advantage is at this link.
