I received a call a short time ago from a woman calling on her mother’s behalf. The mother lives near the local office, but the daughter lives over 200 miles away. Why am I telling you this? During my conversation with the daughter, whom I’ll call Sue, I learned that Sue’s mother was convinced by a local salesperson to drop her Medicare Supplement policy and enroll in a Medicare Advantage plan from a company that I won’t name. Now, normally that wouldn’t be a big deal, except that in this case there are extenuating circumstances.
What Sue’s mother didn’t know was that the sole hospital in her county would not have accepted her plan if it were presented to them. In fact, they would have only accepted one of two different Medicare Advantage Plans. Not only that, but because of associations with the hospital, many physicians in her county wouldn’t have accepted that plan either.
Fortunately, Sue’s mother didn’t have a serious injury or illness during that time or this tale may have had a tragic outcome. Unfortunately for all other Medicare beneficiaries, the salesperson that sold Sue’s mother her plan is still out there peddling policies.
BE CAREFUL!
If you are considering replacing your Medicare Supplement policy with a Medicare Advantage Plan, proceed with caution. At a minimum, you should consider the following before making a final decision:
- Doctors and physicians have the right to accept or reject a Medicare Advantage PFFS plan on a patient by patient and a visit by visit basis. Call your physician and ask specifically about the plan that you’re considering.
- Call your hospital’s administrative offices and ask if they will accept the plan that you’re considering as well; they might not.
- Each Medicare Advantage plan has its own formulary, which can vary drastically from plan to plan. Use the plan’s formulary booklet to confirm that your medications will be covered. Also, make sure you know how much your prescription copays will be once the plan becomes effective.
One final note, if you are currently enrolled in a Medicare Advantage Plan and are not happy with it then you may be able to return to Original Medicare if certain conditions are met. If you find yourself in this group then I highly suggest that you contact a reputable local insurance professional to explore this option.