Now that Open Enrollment is upon us, we're sure that all of your patients are coming to you with questions about which plan is right for them!
While a majority of your patients will have the most benefit from enrolling in a Medicare Prescription Drug plan, some of your dual eligible patients, patients that are institutionalized, in end stage renal disease, or have other chronic illnesses, may benefit from enrolling in a Medicare Advantage Plan.
What sets Medicare Advantage plans aside from regular Prescription Drug Plans is the extra coverage they offer. Advantage plans often times have extra hearing, dental and vision coverage. When switching a patient from one plan to another, you should make sure that the new plan includes the extra coverage as well.
To find out if their physician is in-network on an Advantage Plan, it is best to call the physician and ask them directly if they accept the new plan.
Anyone can join an advantage plan, but one must have Medicare Parts A and B and live in the plan’s service area to be eligible to join.
Some patients may want to stick with a PDP plan, so they have the freedom to choose which doctors and hospitals they visit with Original Medicare. On a PDP, patients can go to any doctor or hospital that accepts Medicare. Medicare Advantage Plans, or MA-PDP plans, limit a patients' doctor and hospital network. There are also hidden copays that could go into different Advantage Plans. Patients also have to abide by the rules of the plan, or they may face higher out of pocket costs.
The bottom line, if a patient is very healthy, and expects to have less than $10,000 in health expenses per year, it might be best to stick with a PDP plan and Original Medicare, and enroll in a Supplement (Medigap) Plan F or N to cover most of their health expenses.
If there is a chance that the patient will have a great amount of medical expenses or hospitalizations per year, have several doctors they are seeing for various on-going treatments, and does not mind restricting their doctors' network; a Medicare Advantage PPO plan might save them the most money due to lower premiums.