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Health Scene •
www.bmhsc.org
It’s that time of year
when you
have the chance to sign up for a
Medicare Advantage plan or change
from one plan to another.
But before you sign on the dotted
line, be sure the plan you’ve chosen
has you covered. If your doctors
and hospital are not in the plan’s
network of providers, you could
end up paying more for medical
services. Don’t assume because it’s
an AARP-endorsed company that
the plan is the best possible choice
for you. There are several options
in our market area, if you decide an
Advantage plan is right for you.
“Most people have no idea they
have to ask to find out if their
healthcare providers are in the
insurance company’s network,” says
Jeff White, Beaufort Memorial’s
senior vice president and chief
financial officer. “If they’re not part
of the plan, you’ll have to pay more
out-of-pocket costs—and that can
be substantial.”
a different insurance company, you
will be automatically re-enrolled
in your current plan. Be aware, the
plan’s rules and participants can
change each year, so you will need
to
confirm
that your healthcare
providers are still part of the insur-
ance company’s network.
“Some insurance companies don’t
advertise who is in their network
and don’t tell you that you will pay
more if you go to an out-of-network
provider,” White says. “If you don’t
ask, you may not find out until it’s
too late that, as a patient, your re-
sponsibility is higher than expected
for medical services because your
doctor or hospital is not in the plan.”
Who works with BMH?
Beaufort Memorial is part of six
Medicare Advantage plans. They are:
➜
➜
Medicare-Aetna (MCR
Advantage PPO/HMO plans).
➜
➜
Medicare-Ambassador PPO
(MCR Advantage plan under
America’s 1st Choice).
➜
➜
Medicare-Blue (MCR Advantage
PPO plans).
➜
➜
Medicare-Humana Choice PPO.
➜
➜
Medicare-Patriot PFFS (MCR
Advantage plan under America’s 1st
Choice).
➜
➜
Medicare-Windsor Sterling Gold
Plus (MCR Advantage plan under
Sterling).
“We’ve had patients ask us
to write off the extra expenses
they’ve incurred because we’re
not in their plan’s network,” White
says. “We don’t belong to some
plans because the companies pay
providers significantly less than
Medicare's cost-based standard
reimbursement.”
Medicare Advantage
Making
sense of
your plan
How the plans work
Sometimes called a Part C or MA
plan, a Medicare Advantage plan is
another health plan choice you may
select instead of traditional Medicare.
These plans are offered by private in-
surance companies and provide all of
your Part A (hospital insurance) and
Part B (medical insurance) coverage.
Medicare Advantage plans are
responsible for all of the services
Medicare covers, including emer-
gency and urgent care. These plans
are not supplemental coverage, but
take the place of traditional Medicare.
Medicare Advantage plans may offer
extra benefits, such as vision, hear-
ing, dental, and health and wellness
programs. Most include Medicare
prescription drug coverage (Part D).
Although participating insurance
companies must follow rules set by
Medicare, each Medicare Advantage
plan can charge different out-of-
pocket costs and have different
rules for how you get services. For
instance, you may need a referral
to see a specialist or you may be
required to go only to doctors or
facilities that belong to the plan for
nonemergency or nonurgent care.
If you are treated by a doctor or
hospital that doesn’t belong to the
plan, your services might not be cov-
ered or your costs could be higher.
Check with the insurance company
to find out if they will cover a par-
ticular service and what your costs
may be
before
obtaining the service,
if possible. You may be required to
obtain prior approval for certain
procedures to avoid higher costs.
Be sure—ask first!
Since not all Medicare Advantage
plans work the same way, it is impor-
tant to find out the rules and costs
of a plan—and if your doctors and
hospital are in the plan’s network
of providers—before you sign up.
In most cases, you are enrolled in a
plan for a year and cannot change
plans until the next open enrollment,
which could be up to one year later.
Open enrollment for Medicare
Advantage plans is October 15
through December 7. If you are
already in a plan and do not select
Take advantage!
If you want to confirm that Beaufort
Memorial participates in a specific
Medicare Advantage plan, please
go to our website,
www.bmhsc.org
, or call
Robin Poehnert, manager
of the hospital’s Cost and
Reimbursement Department,
at
843-522-5794
.