With Medicare open enrollment happening now, it’s important to think about how the choice you make today could impact your well-being tomorrow. Because we understand how overwhelming this process can be, we want to make you aware of some important considerations.
If you are eligible for Medicare, you can make one of three choices:
- Traditional Medicare, which has copays and deductibles (AKA, “original” Medicare)
- Traditional Medicare with Medigap (a private supplemental policy) that covers Medicare’s copays and deductibles
- Medicare Advantage (MA), private insurance that varies greatly depending on the policy you choose
Medicare Advantage (MA) Plans Are Not For Everyone
Many people are drawn to Medicare Advantage plans because of their low-cost premiums and seemingly extensive covered services, but the devil can be in the details. As they start to use and need their new Medicare Advantage plan, patients often say they wish they had known about the following:
- Out-of-Pocket “Surprises”
Medicare Advantage plans may offer $0 premiums, but the out-of-pocket “surprises” may not be worth those initial savings. Participants who suffer from chronic conditions often find that medical care costs skyrocket under a Medicare Advantage plan due to deductibles, copays, coinsurance and out-of-pocket expenses. Snowbirds who live in more than one state throughout the year are often impacted greatly by these out-of-pocket expenses since most Medicare Advantage plans only operate within a certain region. Care frequently ends up costing more to the patient than it would under Traditional Medicare. - Very Limited Doctors and Healthcare Providers
Most Medicare Advantage plans impose restrictions on patients when choosing doctors, hospitals or other providers, requiring you to stay within their network. While this keeps the profits up for the insurance company, it limits your choice. Many patients are unable to see the providers recommended to them because they are not part of the plan’s limited network. What’s more, plans often drop providers without notice, breaking the continuity of care even when patients have found someone they trust. This is why a recent government watchdog report has urged Medicare authorities to do a better job policing the adequacy of these networks.
Traditional Medicare Covers You When You Need It
Oftentimes people hesitate before enrolling in Traditional Medicare, as the premium can be considerably more than the alternative Medicare Advantage plans. However, as the saying goes: You get what you pay for.
- Comprehensive Coverage
What you’re paying for is the coverage for all the days you’ll need medical care when you’re sick or trying to prevent getting sick. This includes a stay in the hospital, a visit to a doctor, having a procedure, doing physical therapy, having imaging done or sitting for a lab test (to list just a few). Would you be shocked to know that, in Fort Lauderdale, FL, Medicare beneficiaries spend an average of 24.3 days per year receiving medical care? That’s nearly one month a year – and more than 40% higher than the national average. The most comprehensive coverage, which will result in the fewest out-of-pocket expenses, is a traditional Medicare plan paired with a Medigap policy (i.e., a supplement). - Access to the Best Doctors, Providers and Facilities
More than 90% of the country’s doctors accept Traditional Medicare. This means that once you enroll, you can likely continue to see your current doctors who you trust and are familiar with your health history. What’s more, if you fall ill, you’ll have access to best-in-class specialists. In stark contrast, nearly half of the Medicare Advantage plans offered in South Florida limit patients to less than 30% of doctors.
Switching Back to Traditional Medicare is Complicated
The fact is, many make the common mistake of assuming that because they are healthy at that time, they can probably try a Medicare Advantage plan and enroll for this year (at least). However, the sad truth about getting older is that you are likely to need some sort of substantial medical care in the future, and even trying a Medicare Advantage plan could have lifelong implications if this happens.
The problem is, when you do become interested in switching to Traditional Medicare, insurance companies are allowed to apply medical underwriting for Medigap plans once you’re beyond your initial enrollment period at age 65. That means it’s very likely the insurance companies could either deny you outright because of a preexisting condition or they’ll charge you a higher premium.
Medicare Enrollment Impacts Necessary Physical Therapy
Considering everything, you could end up using your Medicare benefits most frequently for physical therapy. Some of the most common reasons people are prescribed physical therapy include:
- Managing chronic pain – suffered by 50%-80% of older adults
- Rehabbing after surgery – such as joint replacements and repairs which account for 1 in 3 surgeries performed in the U.S.
- Preventing and recovering from falls – when you consider that an older adult is treated in the emergency room for a fall every 11 seconds
- Managing chronic conditions – with 80% of Medicare eligible recipients suffering from at least one
- Minimizing physical decline – considering you lose 3% of your muscle strength each year after passing middle age
Under Traditional Medicare with a Medigap policy, there are no out-of-pocket expenses for physical therapy visits. Conversely, most Medicare Advantage plans will require a copay of $30-$40 on average, per visit. For a patient with a prescription for 6 weeks of physical therapy at 3 visits per week, that’s more than $500 just to see the physical therapist.
Additionally, many Medicare Advantage plans will limit the number of times you can visit a physical therapist throughout the year. However, with Traditional Medicare, there are no limits on the number of times you can visit a physical therapist, as long as it is deemed medically necessary.
Learn More
Learn more about Clear Choice Physical Therapy and how we can help you stay healthy and navigate your medical issues after the age of 65. Not only will we create a customized therapy treatment plan for you, but we’ll also offer insight and guidance to help you choose the best Medicare option to cover your treatment needs. Contact us today!
