medicare-advantage-image-800Medicare open enrollment starts soon. This is the fun time of year when seniors attempt to decipher the available Medicare Advantage plans and decide in which plan to participate or if they would be better off in Original Medicare. Patients often look to their providers for help in determining their best option. While providers cannot and should not make this decision on their patient’s behalf, providers can educate their clientele about their options and avoid uninformed and unhappy customers.

There is a lot of confusion among seniors and pre-retirement individuals about Medicare Advantage plans and plans sold through the online “marketplace.” If a person is Medicare eligible, he/she cannot purchase coverage through the marketplace no matter what they may be told by unscrupulous insurance agents. They do not need to purchase any coverage from the exchanges in order to maintain their Medicare benefits.

Beneficiaries should also know that Medicare Advantage is not Medicare Supplement (aka MediGap) insurance. To enroll in MediGap, one must already be enrolled in Original Medicare. MediGap is private insurance purchased to cover some or most of the out-of-pocket expenses found in Original Medicare. Because Medigap policies have the same benefits regardless of the payer, patients should be advised to shop around for the best prices. Medicare Advantage replaces Original Medicare completely. Provided by private health plans as an alternative to Original Medicare, Medicare Advantage Plans are required to offer at least what Original Medicare offers. After that baseline, the plans vary widely offering different copayments and different benefits.

Most Medicare Advantage plans require that the patient utilize in-network providers. Therefore, it is imperative that patients understand which providers are in and out of network in any plan they are considering. Choosing a plan, only to discover after the fact that their providers are not in-network, can cost a patient a great deal financially, should he/she choose to see an out-of-network provider or emotionally, should he/she choose to start over with a new, untrusted provider.

Appearing virtually free at the outset, some Medicare Advantage plans are often misleading. Patients may be in for an unpleasant surprise when they learn they have to pay more in the end. Prior to enrolling in any Medicare Advantage plan, a patient must understand what their out-of-pocket costs can potentially be.

Another consideration is that not all Medicare Advantage plans include prescription coverage. For seniors, prescription costs can be substantial and not having such coverage is not an option.

Understanding exactly what is covered prior to enrolling in a plan will save patients from a myriad of difficulties later. Providers can help their patients by educating them in general terms Medicare Advantage plans as well as the offerings of Original Medicare. The specifics of Medicare Advantage and MediGap should be left to licensed insurance agents.

Managed Care Partners has a program in place to educate seniors about Medicare and Medicare Advantage plans. If you would be interested in learning more about how we can help you educate your patients, please contact Jim Richmond at