Know the risks of Medicare Advantage before choosing your 2025 plan

Medicare open enrollment season is underway and we encourage eligible community members, who are generally age 65 or over, to review their plan. The open enrollment period for switching Medicare Advantage plans runs from October 15 through December 7, 2024. A second open enrollment period begins January 2 through March 2025. Traditional Medicare and Medicare Advantage may sound like similar plans, but there are distinct differences that are important for plan members to know. Too often, the differences come as a surprise to plan members at a time when services are needed most. Medicare Advantage might sound appealing due to its name because of the positive portrayal on high-dollar commercials, the promise to cover all aspects of your care and seemingly lower out-of-pocket payments. "Advantage" does not mean the plan will be better for you or your health care provider, as these plans come with significant risk. Additionally, Medicare Advantage plans are not offered by or through Medicare itself, leading to additional confusion. When you choose an Advantage plan, you give up traditional Medicare coverage for an option that is increasingly denying a large percentage of claims. Over the last few years, we have had numerous patients share that they are struggling to receive the follow-up care prescribed by their healthcare providers. For example, Firelands Health has observed Medicare Advantage plans that are delaying or denying admission to and care within facilities such as nursing homes, rehabilitation centers and hospitals. In review of what is happening, our providers are noting that the prior authorization process used by Medicare Advantage plans often delays care for our patients. You are encouraged to read more about the risks of Medicare Advantage plans from our neighbors at the Kentucky Hospital Association by visiting kyha.com/medicare-advantage. Medicare Advantage is increasingly dominated by large for-profit insurance companies that are accountable to their shareholders – not to patients or hospitals. As a result, they are continually finding loopholes in federal regulations to capitalize on your tax dollars. As a result of these practices, patients in our community are being forced to travel long distances from their home communities for a provider their Medicare Advantage plan will cover. They may also find that their Medicare Advantage plans have changed the list of medications they will cover without notice to patients, causing additional confusion. At Firelands Health, we are continuously working to help our community navigate their insurance claims as Medicare Advantage companies identify creative ways to avoid payment. Our country's health care system is already too complex and Medicare Advantage plans are making it even more complex for both patients and health care providers. There is another solution, and it is not the "Advantage" you see advertised. Choosing traditional Medicare over Medicare Advantage can lead to better outcomes for patients and health care providers. Traditional Medicare puts the choice for when, where and how you receive care back in your hands. A recent Consumer Reports analysis of Medicare options identified that more people in rural areas like ours are going back to traditional Medicare because of the issues highlighted above. While many factors may influence your plan choice, we urge you to consider the impact on your access to quality health care when making your decision. We know having to evaluate your coverage each year is difficult and time-consuming for you and your family. Resources for comparing plans are available through the Ohio Department of Insurance at insurance.ohio.gov/medicare or medicare.gov. Serving Our Seniors provides an excellent resource for counseling to compare and contrast Medicare plans, so you can make an informed decision. To request a Medicare appointment, please call Serving Our Seniors at 419-624-1856. Appointments may be delayed until after Dec. 7, 2024. Firelands Health is committed to delivering care that is accessible, affordable and convenient. The open enrollment period is a great time to select a primary care provider and to schedule your annual wellness visit. Please call 419-557-5591 to become one of the thousands of patients we care for every day. Jeremy Normington-Slay President & Chief Executive Officer, Firelands Health Sue Daugherty Director, Serving Our Seniors