Medicare health plan choices for seniors: Fresno expert offers the ‘rest of the story’
I am a small business owner and retired CEO of a not-for-profit organization, where I oversaw the selection and approval of the health plan purchase for employees. In addition, I worked for eight years as vice president of a life and health insurance and financial services firm. I’ve seen all sides of our country’s private and public health plan scenario.
Reliable, easy-to-understand, and affordable health plan coverage is vital for all our citizens, particularly seniors. When seniors make their Medicare health plan decision, they should understand the basics of original Medicare and Medicare Advantage plans. My concern is many seniors aren’t getting all the information they need to make this decision in the opaque and complex health-care market financing.
The original Medicare health plan is administered by the Centers For Medicare and Medicaid Services (CMS), with providers paid by CMS for services delivered to subscribers. Medicare Advantage plans are private or publicly traded, not-for-profit or private equity financed health plans that contract with CMS. Medicare Advantage plans flood seniors with mail, TV and radio ads, emails, texts and phone calls, selling their plan as the best choice for Medicare coverage. With the deluge of Medicare Advantage marketing, many seniors may not know original Medicare is still available and can be an excellent option, nor understand some of the potential issues with Medicare Advantage plans.
A few critical points seniors should be aware of that may not be mentioned by Medicare Advantage marketing include:
▪ Medicare Advantage plans tout their zero-dollar premium, Part D prescription drug, and basic dental and vision coverage. But, with most Medicare Advantage plans, you still need to pay the Medicare Part B premium, the same as in Original Medicare. The 2023 Part B premium is $164.90 for both options.
▪ Medicare Advantage Plans are HMOs or PPOs with specific provider networks. In these plans, the subscriber is limited to providers in the plan’s network and subject to out-of-network costs that can be substantial if their provider isn’t part of the Plan network. Original Medicare subscribers have the freedom to see any provider that accepts Medicare, which the vast majority of providers do.
▪ Medicare Advantage plans may make network changes and business decisions negatively affecting subscribers. For example, Forbes noted that Bright Health Group announced, “it will no longer offer Individual and Family Plan products through Bright Healthcare in 2023, or Medicare Advantage products outside of California and Florida.” These decisions can negatively impact subscribers who will need to find a new plan.
Four years ago, when I attended Medicare Advantage marketing meetings, the issues mentioned above were not fully disclosed. I knew about these issues, and we decided to subscribe to original Medicare, purchase Part D prescription coverage, and a Plan F Medicare Supplement plan. I already had an account opened with medicare.gov, so it was simple (15 minutes) to make an online application. Plan F is no longer available to new subscribers, but Plan G will offer excellent payment for original Medicare co-pays and deductibles. In addition, we enjoy the freedom of access to all providers that accept Medicare patients. We enjoy peace of mind without worrying about out-of-network issues, co-pays, and deductibles. Over four years, after shoulder surgery, cataract surgery, and routine medical visits and tests, we have paid a total out-of-pocket of $200. Medicare is the best and easiest-to-use health plan coverage we’ve ever experienced.
The Wall Street Journal published an excellent article, “What Is a Medicare Advantage Plan and Should You Sign Up For One.” I recommend reading before deciding on your health-care plan choices.
Leon Hoover is a Fresno resident and recently retired CEO of Kings View Behavioral Health.
