Tuesday, October 31, 2017

What is the Difference Between Original Medicare and Part C?

We are in the thick of Medicare enrollment, so the story from Kaiser Health News explaining the differences between original Medicare and Medicare Advantage is quite timely. Medicare Vs. Medicare Advantage: How To Choose  reports that the Part C offerings are pretty stable for 2018 and in fact there are available the highest number plans for purchase all over the US.   The article explains some of the foundational concepts for Part C plans:

Basics:

Medicare Advantage plans must provide the same benefits offered through traditional Medicare (services from hospitals, physicians, home health care agencies, laboratories, medical equipment companies and rehabilitation facilities, among others). Nearly 90 percent of plans also supply drug coverage.

Pros from CMS:

Little paperwork. (Plan members don’t have to submit claims, in most cases.)... An emphasis on preventive care...Extra benefits, such as vision care, dental care and hearing exams, that aren’t offered under traditional Medicare....An all-in-one approach to coverage. (Notably, members typically don’t have to purchase supplemental Medigap coverage or a standalone drug plan.)....Cost controls, including a cap on out-of-pocket costs for physician and hospital services (Medicare Part A and B benefits).

Cons from CMS:

Access is limited to hospitals and doctors within plan networks. (Traditional Medicare allows seniors to go to whichever doctor or hospital they want. ...Techniques to manage medical care that can erect barriers to accessing care (for example, getting prior approval from a primary care doctor before seeing a specialist).... Financial incentives to limit services. (Medicare Advantage plans receive a set per-member-per-month fee from the government and risk losing money if medical expenses exceed payments.) ... Limits on care members can get when traveling. (Generally, only emergency care and urgent care is covered.) ... The potential for higher costs for specific services in some circumstances. (Some plans charge more than traditional Medicare for a short hospital stay, home health care or medical equipment such as oxygen, for instance.) ... Lack of flexibility. Once someone enrolls in Medicare Advantage, they’re locked in for the year. There are two exceptions: a special disenrollment period from Jan. 1 to Feb. 14 (anyone who leaves during this time must go back to traditional Medicare) and a chance to make changes during open enrollment (shifting to a different plan or going back to traditional Medicare are options at this point).

The article also discusses the implications for Medigap policies if the beneficiary switches enrollment to original Medicare and the premium costs for Part C plans. The article recommends a close look at the drug costs under the plan. The article concludes with a discussion of selecting doctors that participate in the beneficiary's plan. 

Helpful article!  Assign it to your students.

 

http://lawprofessors.typepad.com/elder_law/2017/10/what-is-the-difference-between-original-medicare-and-part-c.html

Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

Comments

I realize my reply here is made before I’ve had a chance to read the article … but I thought there was another occasion that permitted exiting an Advantage plan and going into original Medicare. That occasion is entry into long term care in a nursing home. I wonder if that option is still available. If not, that ability has been removed since 2010, when I arranged the flip with my mother when she moved into a nursing home. I was also able to enroll her in a bare-bones supplement (Medigap) at the same time. Unfortunately I cannot recall, but I believe we had to apply for the supplement and have her rated. (In other words, not on an open enrollment basis like when one first goes into Part B). Reason for making the flip: I didn’t want the long-distance hassle of network-only medical care, especially if her physician might choose to leave the network. The flexibility was worth the additional cost.

Posted by: Jennifer Young | Nov 1, 2017 5:44:37 AM

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