Common Medicare Advantage Nightmares and How To Avoid Them
Whether it’s something not being covered or a bill you weren’t expecting, healthcare surprises are absolute nightmares. Unfortunately, Medicare Advantage nightmares are all too common. The good news is that many Medicare Advantage issues can be avoided if you have a good Medicare advisor who helps you pick the right plan for your needs. Read on to learn about the most common Medicare Advantage nightmares and how you can avoid them.
Unable to afford care due to high out-of-pocket costs
Medicare Advantage plans have varying out-of-pocket costs. If you’re on a plan with a high deductible and high coinsurance amounts, you may find yourself unable to afford your share of healthcare costs.
How to control your out-of-pocket costs
If you need frequent or expensive treatments, pairing a Medicare Supplement plan with Original Medicare is generally the best way to save. Unfortunately, not everyone can afford Medicare Supplement plan premiums. You’re also not always guaranteed acceptance into a Medicare Supplement plan.
If you can’t afford the premiums that come with Medigap plans, you should look for Medicare Advantage plans with low annual deductibles, coinsurance amounts, and out-of-pocket maximums. This will help reduce your costs. A Chapter Medicare agent can help you quickly compare your estimated annual costs and recommend the plan that will save you the most.
Delayed care due to prior authorization requirements
Receiving the care you need in a timely manner matters. While Original Medicare doesn’t require prior authorization for covered services, Medicare Advantage plans often do. Unfortunately, prior authorization denials are common, and this is one of the biggest drawbacks of Medicare Advantage plans.
If authorization is denied, you may experience a delay in care—or end up foregoing treatment entirely. In some cases, this can cause serious consequences to your health.
As an example, I want to share a story from a Medicare Advantage enrollee we spoke with a while back, who suffered physical hardship due to a prior authorization denial. This woman had experienced multiple strokes and had undergone brain surgery. She had ongoing health issues and her neurologist wanted to perform a diagnostic procedure. The procedure was denied by her Medicare Advantage plan provider. When she appealed the denial, she discovered that the request was denied due to an admin error. The approval didn’t come until four months later, at which point her health condition had worsened.
When dealing with serious medical conditions, stress is high, and delays matter. This is just one example of how prior authorization can have serious consequences.
How to ensure you receive the care you need when you need it
If you’re on Original Medicare, you won’t need prior authorization for covered services. If you prefer Medicare Advantage, you can enroll in a plan with an insurance company that’s less likely to require prior authorization.
If you enrolled with a plan using Chapter, we’ll help you through prior authorization requests, denials, and appeals. Our Medicare Advocates will also help you with several other things, including lapses in coverage and getting Extra Help to pay for prescription drug costs.
Preferred healthcare providers aren’t covered
When you’ve been going to the same doctor, dentist, or hospital for years, it’s normal to want to stick with those healthcare providers. Change can be scary in any part of your life, but when it comes to your healthcare, sticking with the people and places you trust can provide necessary comfort. One of the common issues people face with Medicare Advantage plans is that only certain plans have networks that include all their healthcare providers.
How to ensure you can see your preferred providers
When you’re enrolling in a Medicare Advantage plan, have a list of all your preferred providers handy so you don’t forget any of them! We’ll ask you for your doctors’ information and plug that into our system to ensure we’re only looking at plans that have your doctors in their network.
If you have a lot of doctors and specialists, Original Medicare may be a better option to ensure you can see the doctors you know. With Original Medicare, you can see any doctor who accepts Medicare.
A specific treatment or piece of equipment isn’t covered
Especially if you have a chronic condition, you may have specific prescriptions or equipment that you’ve been using. For example, if you have diabetes, while all prescription coverage options will cover insulin, not every plan will cover the specific type of insulin you’ve been using. And, even if a plan covers your type of insulin, it may be more expensive.
How to ensure your specific needs are met
Always check that all of your healthcare needs are met by the plan you choose. If you prefer a certain brand name drug, make sure to mention that to your Medicare Advisor to ensure you aren’t surprised by the cost of your prescriptions or complete lack of coverage.
A plan’s extra benefits are unclear or not worth it
One of the reasons Medicare Advantage enrollees choose to enroll in these plans is to get the extra benefits that they come with. Original Medicare doesn’t cover dental, vision, and hearing care—but Advantage plans usually do. Unfortunately, due to aggressive advertising tactics and variance between plans, the extra benefits you’re receiving are often confusing. In many cases, the value of those benefits isn’t what people expect. In other cases, with benefits like Medicare OTC cards, claiming your benefits can be confusing. Finally, in the worst scenario, by prioritizing these extra benefits, you may end up paying more for the healthcare and prescriptions you need.
How to ensure you get the best value from your coverage and benefits
Ask questions! Especially once you’ve narrowed your plan options down to 1-3, ask what each comes with and make sure your most important healthcare priorities are met.
If you’re having trouble using the benefits that come with your plan, get help! If you enrolled in a plan with Chapter, our Medicare Advocates will help you use the benefits you’re owed. You can also use the Chapter OTC app to claim your OTC benefits easily.
Avoid confusion and Medicare nightmares with help from an agent
Most Medicare Advantage nightmares are avoidable! When enrolling in Medicare, it’s important to understand the key differences between Medicare Advantage and Original Medicare. You should also understand your other Medicare coverage options: Part D (prescription drug coverage) and Medigap plans.
A Chapter Medicare agent will explain all of your Medicare coverage options to help you make the most of your Medicare. Get all your questions answered and compare plans without any obligation. Call us today at 855-900-2427 or schedule a time to talk.