October 15th -December 7th is Open Enrollment Period for Medicare. Most US citizens, 65 and older, are entitled to Medicare coverage. Medicare Parts A, B, and D, cover all Medical, Hospital, Rehab, Outpatient and Pharmacy bills. Most services are covered at 80%. Combined with a good supplementary policy in addition to Medicare A, B and D, coverage increases to 100%.
In recent years, many insurance companies very activelyencourage Medicare participants to join Medicare Advantage or Medicare Complete managed care plans. Participants are told that they will not need to change providers and all prescriptions will be covered. Unlike a supplementary policy, there is NO MONTHLY COST for participants. Insurance companies also offer bonuses like eyeglasses etc. to get you to sign on. Many seniors enroll in these plans and are locked in until next Open Enrollment Period.
TOO GOOD TO BE TRUE?
YES, THERE ARE SERIOUS ISSUES WITH THESE PLANS
Many top hospitals no longer participate in many managed care programs. That means if you want the best doctors, your hospitalization and the surgeon you prefer will not be covered.
On US Medicare (White card with Red and Blue lines) tests like MRI’s, CT scans, IR procedures, etc. do NOT need prior approval. Managed Care can deny any of the above procedures, at their own discretion.
If someone, Chas V’Shalom, suffers a heart attack, stroke etc. and needs a specialized facility to recover, most Managed Care plans will NOT approve. On straight Medicare one is automatically approved for the type of facility they require, based on meeting medical criteria.
When you just turn 65 and are healthy, it is easy to think you can save money and still get full coverage, so why not? Unfortunately, Chayim Aruchim gets many calls from distraught families, whose loved one suffered a sudden stroke, cardiac arrest, brain tumor etc. Chayim Aruchim is committed to helping our community get the highest quality care. These Managed Care programs will NOT cover this level, leaving no recourse but to pay 10’s of 1000’s of dollars on their own.
If you are enrolled in Managed Care, once you pass the December 7th deadline, you are locked in for the year. There is NO option to make changes mid-year.
Call your medical insurance agent or Mrs. Leah Bald (732) 276-6590.
This article is misleading to only focus on managed care (HMO) plans. There are many excellent PPO plans with excellent networks, like Aetna, under Medicare Advantage that do not have any of these issues.
Is this an advertisement?