Reply to PSA-65 year olds (Medicare Part A)---Remember to Sign up!

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Is it difficult to find or keep doctors who take Medicare? I ask because I’ve heard the government’s reimbursements are lower and the paperwork more onerus for medical practices. [/quote]

It is not hard. If you choose the original Medicare program (not a Medicare Advantage plan), you can go to any doctor that participates in Medicare, and about 98% do. Same with hospitals, outpatient clinics, etc. There are a few special areas where it can be hard, namely psychiatrists and similar mental and behavioral health specialists, because many of them don’t take insurance at all.

If you choose a Medicare Advantage plan, specifically an HMO plan, you will need to stick with doctors in their network. It is the same as having a plan today — if you are with Cigna, you need to go to providers in Cigna’s network. Or Carefirst providers if you choose them as your plan. [/quote]

Right, and one of the nice things about traditional Medicare is that you never face prior authorization requirements. Your doctor thinks you should get an MRI? You don’t have to get an insurance company to sign off on it, you just get it.

You do need to purchase supplemental insurance, however, like Medigap coverage. That helps pay for out-of-pocket costs not covered by Medicare. You will also need to buy a stand-alone Medicare Part D prescription drug coverage plan, since original Medicare doesn’t cover prescription drugs.

All these premiums can add up, which is one reason some people opt for Medicare Advantage, which typically covers rx drugs and most of the out of pocket costs that a Medigap plan would cover — often for less money. There also is usually an annual out of pocket maximum with Medicare Advantage that you won’t get in traditional Medicare without buying a supplemental Medigap plan.

The tradeoff with Medicare Advantage, with plans run through private insurance companies, is that you have to jump through prior authorization hoops to get some services (like an MRI), and you are usually stuck with the plan’s network of physicians and hospitals. That’s usually not a big deal if you are relatively healthy and don’t need much care. But if you do get sick with, say, cancer and want to see a specialist at Hopkins and have surgery there, the plan may say, sorry, that doc and hospital are not in network. You’ll have to have your surgery by one of these other docs, and at George Washington University Hospital (or some other hospital—I am just grabbing a name here).

Also, once you have been on a Medicare Advantage plan for a while, you can’t switch back to traditional Medicare without facing medical underwriting for the supplemental Medigap plan that you will need to protect yourself against high out of pocket costs. So if you are sick and have pre-existing conditions, you may get charged much higher premiums for that coverage — something that no longer happens in the pre-age 65 private insurance market thanks to the ACA. (And you can’t switch to an ACA plan because if you are eligible for Medicare you can’t sign up for an ACA plan, at least not with federal subsidies.) So a lot of people who were happy with Medicare Advantage when they were 66 and relatively healthy feel trapped in it when they are 76 and sick. Medicare Advantage can be a good option, especially for seniors without much money who can’t afford supplemental coverage, but it’s definitely not a slam dunk and there are potentially big tradeoffs and drawbacks to going that route.[/quote]

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