FOR IMMEDIATE RELEASE
September 12, 2024
FOR FURTHER INFORMATION, CONTACT:
Ginger Dreyer, Senior Director of Communications
Kentucky Hospital Association
502-426-6220
gdreyer@kyha.com
Understand Your Options and the Risks Before Open Enrollment
Medicare Open Enrollment is October 15 through December 7
LOUISVILLE, KY – (September 12, 2024) Medicare open enrollment is scheduled to run October 15 through December 7. That’s when seniors can switch coverage between Traditional Medicare and Medicare Advantage or change a prescription drug plan.
Traditional Medicare is a health plan managed by the federal government that has two parts: Part A (hospital insurance) covers inpatient hospital and skilled nursing care, and Part B (medical insurance) covers physician services. This is the typical Medicare insurance with which most people are familiar. These plans typically cost about $175 a month, with the cost deducted from your social security check.
Many people also purchase Medigap, which is not run by the federal government, but is used to cover health care costs that Traditional Medicare does not cover, such as copays and other out-of-pocket expenses. Medigap essentially “fills the gap” between what you pay and what Traditional Medicare covers. It does not, however, include prescription drugs. A separate Part D plan can cover prescription drugs when you have Traditional Medicare.
Medicare Advantage, sometimes called Medicare Part C, is a health plan offered by private insurance companies and can be an alternative to Traditional Medicare. It replaces and cancels your Traditional Medicare plan if you choose this option. It provides the benefits of Part A, B, and often D, usually for about the same cost. If you choose a Medicare Advantage plan, you are not eligible for enrollment in a supplemental Medigap plan. Some Medicare Advantage plans even offer benefits not available in Traditional Medicare, such as fitness classes or vision and dental care.
However, choosing between Traditional Medicare and Medicare Advantage requires careful consideration of your finances and health needs. Medicare Advantage plans often have hidden risks, especially for people with major health issues. Some people in Medicare Advantage plans may end up paying unexpectedly high costs when they become ill, find that their physician network lacks the doctors they need, or discover the Medicare Advantage plan will not approve the necessary care ordered by their doctor.
Ninety-nine percent (99%) of providers accept Traditional Medicare. However, Medicare Advantage plans typically require that you get care from a more limited network of providers, and in most cases, you will need a pre-authorization from the insurance company to see specialists, receive Part B physician administered drugs, get skilled nursing facility stays or inpatient hospital stays, receive mental health services. You may also need a pre-authorization from the insurance company to receive diagnostic services and procedures, labs, tests, therapy, dialysis, hearing, eye exams, dental care, and many other services.
A 2021 study found that rural Medicare Advantage plan enrollees were nearly twice as likely to switch back to Traditional Medicare as those in urban areas. The networks of providers in rural areas are especially narrow, making it harder for people to get care.
In addition, a number of hospitals across the county have decided not to accept Medicare Advantage plans because they can be detrimental to the patients the hospitals serve and often are not reliable in payments for care. This also is true in Kentucky, where there have been an increasing number of hospitals refusing Medicare Advantage plans.
Nearly all Medicare Advantage plans (99%) require approvals and authorizations before care can be given. In a 2022 American Medical Association survey, 94% of physicians polled said authorizations delayed medical care. According to KFF, two million Medicare Advantage requested authorizations and approvals were denied in 2021 by Medicare Advantage plans.
Kentuckians should be aware that the only way to learn about a Medicare Advantage plans’ approval and authorization practices is to ask your physician and hospital. Contact your local health care providers. They can connect you with individuals who can help you navigate the differences between Traditional Medicare and Medicare Advantage.
About the Kentucky Hospital Association: KHA was established in 1929. The Association represents hospitals, related health care organizations and integrated health care systems dedicated to sustaining and improving the health status of the citizens of Kentucky. The Association is headquartered in Louisville.
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