I just discovered something about Medicare and want to pass it along to others who might be on Medicare or who will soon be on Medicare.
Some background: There are two ways you can take Medicare. You can take “Original Medicare” or you can take a “Medicare Advantage” offering.
With original Medicare, Medicare pays 80% of most charges and you can purchase a Medicare supplement policy that will pay the other 20%. When you turn 65 and choose Original Medicare, the companies offering the supplemental policies have to take you, no matter what pre-existing conditions you might have. On Original Medicare you can go to any doctor who accepts Medicare, whenever you choose and as often as you choose.
If you choose a Medicare Advantage plan, you don’t purchase a supplemental policy – the Advantage plan covers all your medical costs. The Medicare Advantage plans are HMOs.
The Medicare Advantage plans are growing, I assume because of the costs advantage.
At any time during open enrollment you can switch between plans.
However, there’s an issue that I just learned about.
The “problem” with a Medicare Advantage plan is that it’s an HMO and that means you have to go to doctors in the plan and you may need a referral from your primary doctor to see a specialist. Some people, when faced with a life threatening diagnosis, choose to switch from the Medicare Advantage plan to Original Medicare so that they can choose which specialist they want to have treat them. And this is where the problem comes in.
You can switch from a Medicare Advantage plan to Original Medicare at any time (during open enrollment), but the companies who offer the supplemental plans are not required to accept you. And if you have some life threatening (expensive) diagnosis they will either not accept you or the costs will be extremely high. They only have to accept you during the initial enrollment period when you qualify for Medicare at age 65.
Nobody ever tells you this when they sell you the Medicare Advantage plan.
Basically, what this means is that once you go with a Medicare Advantage plan you’re pretty much stuck in an HMO unless you can afford to pay the 20% yourself or very high prices for the supplemental plan, especially once you get a life threatening diagnosis.
My advice: Think carefully about enrolling in a Medicare Advantage plan. It could be a one way street.
Mike, who is on Original Medicare.
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