We’re discussing mistakes to avoid when signing up for Medicare. It’s open enrollment time and all seniors must decide whether to stay with their current healthcare plan or make a switch. If you want to switch, this is the time to do it. But beware of possible mistakes you can make.
In Part I of this series, we discussed the two pitfalls to avoid when signing up for your healthcare. Anna Wilde Mathews, writing in The Wall Street Journal, warns us of five pitfalls. The first two pitfalls were avoiding the Medigap Trap and choosing the Wrong Doctors. Today, we will cover the other three pitfalls to avoid.
Paperwork Problems
Medicare Advantage plans can sometimes delay or block access to care. A recent government investigation found some beneficiaries were denied services that should have been covered. You might need to get approval from the insurer before you get a surgery, or a referral from your primary-care doctor to see a specialist. You may also find that those nifty extra benefits touted in ads are extremely limited.
Seniors often don’t focus on these issues, particularly when they are healthy, said Tatiana Fassieux, education and training specialist for the nonprofit California Health Advocates. “Tomorrow you may end up having a stroke,” she said. “Once you start using the more costly care, that’s when the brakes come in.”
To understand the hurdles, you should look at plans in the Medicare.gov tool. As you scroll down each table, you will see small “limits apply” notices next to specific types of care, such as inpatient hospital use or radiology scans. Click on them, and you will find more details about what requirements you might face to get that kind of service, such as prior approval from the insurer.
For a more in-depth explanation, you should go to the insurer’s website and look at key documents, such as the summary of benefits and the full “evidence of coverage.” They are difficult and complicated, but they include pretty much everything there is to know about the plan.
Drug Deficits
Your drug coverage can come through a stand-alone Part D plan—needed if you are in traditional Medicare—or wrapped into your Medicare Advantage. Either way, you can use Medicare.gov to see if your prescriptions are included. This is worth doing every year. You may also want to go to the insurer’s own website and look for restrictions on access as well as the “comprehensive formulary” document that lists all covered drugs.
Biased Advice
Be careful where you turn for advice. Ads peddling Medicare Advantage plans may flash pictures of government Medicare cards and include a toll-free hotline that looks official but isn’t the real federal number. Watch out for websites tied to particular insurers or online agencies that may have strong incentives to push certain plans. One tip is helpful; if the site ends in .gov or .org, it’s more likely to be unbiased. To find real, impartial information, start with Medicare.gov and go from there. There are also counselors in every state under the State Health Insurance Assistance Program. There is also a national helpline maintained by The Medicare Rights Center.
As a senior, and a doctor, I recommend staying with Original Medicare if you can afford the costs, which are higher than Medicare Advantage plans. Original Medicare will give you the greatest freedom to choose your doctors and the least restrictions on the care you will receive. It’s time to choose, but choose wisely.
