Medicare Advantage plans have become dubious payers for many large and small hospitals, which report the insurers are often slow to pay or don’t pay.
When several representatives from private health insurance companies called on him a few years ago to offer Medicare Advantage plan contracts so their enrollees could use his hospital, Jason Bleak sent them away.
“Come back to the table with a better offer,� the Battle Mountain General Hospital chief executive recalled telling them. The representatives didn't return.
Medicare Advantage plans have become dubious payers for many large and small hospitals, which report the insurers are often slow to pay or don’t pay.
5 mistakes you might be making with Medicare open enrollment
1. Not checking your doctors for 2024
Updated
According to a July 2022 report from health care consulting firm Sage Growth Partners, only 4 in 10 people review their plan options each year during open enrollment, which runs from Oct. 15 to Dec. 7 this year.
This leads to Medicare open enrollment misses, including not confirming that your providers are in-network for the next plan year and not comparing your Medicare Part D prescription drug coverage with other available options.
If you have a Medicare Advantage plan, you generally must get medical care from doctors within that plan’s network � and a plan’s network can change at any time. Before you decide to stick with the plan you’re in, make sure your preferred medical providers are still in the plan’s network in 2024.
This may require some legwork on your part, since websites and provider directories aren’t always up to date.
“I was just at a client, and (the plan) said their doctor wasn’t in-network, and it took us calling the provider and looking up a different site on the network side,� says Evan Tunis , president of Florida Healthcare Insurance. “The best thing I would advise is to call the doctor’s office and just confirm with them.�
AP Photo/Pablo Martinez Monsivais, File
2. Not comparing prescription drug plans
Updated
Whether you have Original Medicare or Medicare Advantage, your prescription drug coverage comes from a private insurance company, and it may change what it covers each year. Your regular prescription medication may cost more in 2024, or an insurer may not cover it at all. (Another plan may also cover it for less.)
It pays to plug your drugs into to see what plans they suggest for you. Pro tip: If you log into your account at , your medication history is already there.
“It makes it much easier for them to shop for the next year,” says Katy Votava, who holds a doctorate in health economics and nursing and is president and founder of Goodcare, a consulting firm focused on the economics of Medicare. “They don’t have to tediously put everything in line by line and milligram by milligram.”
AP Photo/Phelan M. Ebenhack
3. Thinking all doctors will take your PPO plan
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A preferred provider organization, or PPO, plan, is a health plan that allows members to see out-of-network doctors, usually for a higher price. People sometimes think that because they have a Medicare Advantage PPO, they’ll be able to see any doctor they want. But providers don’t always take out-of-network coverage.
“Providers � can just refuse someone at the point of service if they don’t want to bill the plan,� Tunis says.
Case in point: Mayo Clinic in Florida is out-of-network with most Medicare Advantage plans and won’t schedule appointments for members with out-of-network Medicare Advantage coverage.
For full provider choice, choosing Original Medicare with Medicare Supplement Insurance, or Medigap, “is the most prudent solution,� Tunis says.
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4. Being swayed by the splashy ads
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Medicare open enrollment season means Medicare commercials galore, and Medicare Advantage plans have appealing things to offer like no premiums and some coverage for hearing, dental and vision care.
But shopping for your health coverage is about more than the side benefits. “Most of the time, honestly � they don’t cover that much dental,� Votava says. “Hearing aid coverage is also very limited, and that’s not the reason to change your plan, so be very careful.�
More important, Votava says, is making sure the plan covers your doctors and prescriptions for the next year.
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5. Waiting too long to ask for help
Updated
Medicare open enrollment ends Dec. 7, but you don’t want to wait until the last day — or even the last week — to start your research. If you have questions, you can get help through programs like the State Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can offer free assistance with your Medicare choices, but they get busy.
SHIP programs in some parts of the country are booking several weeks out. “If you need help, don’t wait,” Votava says.
You can find your local SHIP at .
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Methodology
Sage Growth Partners, commissioned by Healthpilot, surveyed 1,142 Medicare-enrollment eligible seniors (people aged 64 and over) in April 2022. More than 80% of those surveyed had coverage through Original Medicare or Medicare Advantage.
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