protect your healthcare freedom
"Medicare Advantage" is NOT Medicare! Make certain you know the difference BEFORE you enroll!
What are the main differences?
Access to Doctors
Access to Care While Traveling
Access to Doctors
Almost ALL doctors, hospitals, and healthcare facilities participate in TRADITIONAL MEDICARE, and you can visit ANY of these doctors no matter where they are in the country.
Medicare Advantage plans limit your doctor and healthcare facility choices to only those that are in their network.
Specialists
Access to Care While Traveling
Access to Doctors
With TRADITIONAL MEDICARE, you are not required to get a referral to see a specialist. Need to see a Cardiologist, a Podiatrist, or another specialty doctor? You just need to call and make an appointment.
Medicare Advantage plans may require you to visit your family doctor first for a referral and they may also dictate which specialist you can see through their network.
Access to Care While Traveling
Access to Care While Traveling
Access to Care While Traveling
With TRADITIONAL MEDICARE, you are covered no matter where you may travel in the United States. Have an accident while visiting the grandkids in Utah? Not only are you covered under TRADITIONAL MEDICARE, you can see any doctor you like.
Medicare Advantage plans usually limit coverage to doctors and services in its network which is typically in a specific geographic area close to the subscribers home.
Hospital Stay Limits
Access to Care While Traveling
Access to Care While Traveling
With TRADITIONAL MEDICARE, there are no limits to how long your doctor can keep you in the hospital. If you need an extended stay to recover, you are covered for as long as medically necessary.
Medicare Advantage plans may not only limit your stay in a healthcare facility, but can also make decisions about your treatment that may go against what your doctor thinks you need.
Coverage for Labs, X-Rays, and Other Diagnostic Services
Coverage for Labs, X-Rays, and Other Diagnostic Services
Coverage for Labs, X-Rays, and Other Diagnostic Services
With TRADITIONAL MEDICARE, your doctor decides what tests you need, orders them for you, and you are covered when you get them.
Medicare Advantage plans require your doctor to get approval from them first. This process can take up to three days (sometimes longer) and the tests are not guaranteed to be approved. These approvals are based on what the insurance company thinks is medically necessary for you, not what your doctor thinks.
Coverage for Home Health & Medical Equipment
Coverage for Labs, X-Rays, and Other Diagnostic Services
Coverage for Labs, X-Rays, and Other Diagnostic Services
With TRADITIONAL MEDICARE, your doctor decides if you need home health services or medical equipment to use at home, orders them for you, and you are covered when you get them.
As with tests, Medicare Advantage plans require your doctor to get approval from them first. This process can take up to three days (sometimes longer) and the tests are not guaranteed to be approved. These approvals are based on what the insurance company thinks is medically necessary for you, not what your doctor thinks.
Rural Communities
Coverage for Labs, X-Rays, and Other Diagnostic Services
Rural Communities
The benefits that Medicare Advantage plans offer and advertise, such as gym memberships, etc. are often only available to those who live in a large city. Most of the time, these perks are not available in a rural community.
Medicare Advantage plans may also not be contracted in a rural community or may only use certain providers for certain services. Regardless of whether your rural town already has healthcare providers that you can use, you may end up having to drive to a larger city to receive your care, which may put a strain on you or your family.
Know before you enroll
Do Your Research
Medicare Advantage is not the same as TRADITIONAL MEDICARE. There are key differences that can have a real impact on how, when, and where you get the medical care you might need.
Each Medicare Advantage plan is also different.
Comparing each plan’s covered benefits, limits, provider networks, restrictions, and cost-sharing requirements can be challenging, and it can be hard to know if a specific plan will meet your needs should you get injured or sick or become disabled.
Visit the Medicare Website and Compare Plans
It is incredibly important to get the Medicare plan that is right for YOU. Whether that plan is Traditional Medicare or a Medicare Advantage plan, take the time to think of the possibilities that affect both your current health status and any possibilities that may arise in the future.
Attend The Dumas Medicare Education Event
Moore County Hospital District is bringing in Medicare advisor, Greg Downing, on October 25th, 26th, and 27th to offer Medicare education to the Moore County community free of charge.
Greg will provide education to help local seniors get the best plans for their needs and can assist in their enrollment if needed.
Why it's important
Get the Facts Before Committing to Medicare Advantage
As providers at our local hospital, we have the privilege of visiting with members of our community during some of their most joyous moments. And some of their most painful. Unfortunately, some of the more difficult moments have come from seeing our elderly patients scared and uncertain about the next steps in their healing and recovery process because they don’t have the insurance coverage they need for what their doctor recommends.
Since 1965, our country has promised our elderly residents health insurance coverage. A universal health care benefit for anyone 65 and older, no matter their income, medical history, or health status, Medicare today covers approximately 65.5 million of our nation's seniors. Of those 65 million people, just under half have their care decisions managed by a faraway health insurance company, not their local doctors. That’s because they are enrolled in a Medicare Advantage plan, operated by a health insurance company.
These plans are hard to resist. They run frequent TV ads featuring well-known celebrities. They offer extra perks like gym memberships. They might be from the same company that you had coverage with before you retired. And, on the surface they look like they might be cheaper. But, they don’t always cover what you need when you need it. That’s because they are not the same as TRADITIONAL MEDICARE.
With TRADITIONAL MEDICARE, you can see almost any doctor and go to any hospital, anywhere in the country. If you’re visiting grandkids in Dallas or North Dakota and need a doctor, TRADITIONAL MEDICARE would have you covered. TRADITIONAL MEDICARE also covers things like “swing bed” care, which lets you stay in a hospital for speech, physical, or occupational therapy after an accident or knee or hip replacement. Medicare Advantage typically does not. If you need home health care or medical equipment with Medicare Advantage, your doctor has to ask the plan for permission, a process that can take up to three days and can be denied.
Most importantly, with TRADITIONAL MEDICARE, your doctor decides with you what is medically necessary given your condition, prognosis, and support. In a Medicare Advantage plan, those decisions are made by an insurance company employee who doesn’t know you or your doctor.
Everyone deserves choices in health care. Making an informed choice about your health insurance coverage depends on having all the information. We encourage our Medicare-eligible residents to ask questions before selecting a Medicare Advantage plan. Ask if your doctor is an in-network provider. Ask about limits on coverage for hospital stays or rehabilitation after a knee replacement.
Medicare open enrollment begins in October, so now is the perfect time to start gathering information and talking to your health care team. From October 15 to December 7, you can switch back to TRADITIONAL MEDICARE or switch plans.
Everyone deserves choices in health care. And, making an informed choice about what’s right for you depends on having accurate and objective information.
