Leah Kari, Certified Medical Representative
Home delivered meals! Rides to doctor’s appointments! Hearing aids for a zero-dollar copay, and dental care too! These ads flood the airwaves. We dial into a large call center staffed by licensed insurance agents who’ll discuss Medicare Advantage (Medicare Part C) plan benefits. Benefits have restrictions, and you’ll need the facts.
The devil’s in the details: a hospitalization is required to receive home delivered meals. Transportation, restricted to plan approved destinations, requires advance notice. Dental benefits may require using network dentists. Hearing aids at zero-dollar copay might be offered by a very small number of plans.
Medicare Advantage plans (MAPDs) are HMOs (health maintenance) or PPOs (preferred provider) organizations. MAPDs must include every benefit of Original Medicare and most include prescription drug coverage. The benefits mentioned in the ad are included as extras, and not all plans offer all of them. MAPDs are fine ways to receive your care if you understand their requirements.
Most HMOs require referrals to network providers in your plan’s service area. Leave your service area and care is limited to emergency room and urgent care. PPOs require no referrals, and allow accessing care outside of your plan’s service area. Using network providers costs less than going out of network. HMOs and PPOs have rules that members must obey, and any unauthorized services will not be paid for by your plan or Medicare.
MAPDs differ significantly from Medicare Supplements which allow the freedom to see any provider who accepts Medicare across the USA. Depending on the plan, once the monthly premium is paid, you generally do not pay copays and have no networks or referrals. You’ll need a stand-alone prescription drug plan and pay a monthly premium as well. Ask questions to know how these plans work and what you’ll gain and lose if you change plans.
Buyer, beware. Zero-dollar premium plans sound attractive, but you’ll still pay your monthly Medicare Part B premium and also pay the plan copays and coinsurance.
Helpful resources are Medicare at 1-800-633-4227 (TTY 1-877-486-2048) and Medicare.gov. The Arizona State Health Insurance Assistance Program (SHIP) provides free insurance counseling to Medicare beneficiaries. (1-800-432-4040).
During certain times of the year when Medicare beneficiaries may change their coverage, those ads will increase. If you call, you’ll most certainly be invited to enroll in a plan to receive these benefits. Before you dial, resolve to fact find on the first call. End the call and weigh all your options. Be sure to get all the facts before the facts get you.
Leah Sugar Kari, certified medical representative, is a local licensed life and health insurance broker in Tucson. Reach Leah for comments at 520-484-3807 or firstname.lastname@example.org. (TTY users dial 711.)