My elder care coordinator, Lori Kayne, and I recently went to see new clients. A charming couple, 88 and 91 years old, they both struggled with substantial health issues. Yet, they were still in a Medicare Advantage Plan. These managed care plans, otherwise known as Medicare Part C, offer many advantages for healthier seniors. They have minimal co-pays and deductibles and generally cover services that traditional Medicare does not.
However, Medicare Advantage plans are run by private insurance companies and they are managed care plans which means they restrict your choice of providers. This can be especially problematic when you need a specialist. We have also found that our clients who have Medicare Part C have quite limited choices when it comes to picking the rehab facility to go to after a hospitalization. In addition, our experience is that managed care plans tend to cut off rehab stays quicker than the provider would themselves. With Part C, the insurer decides, whereas with traditional Medicare the facility makes the initial decision when they think Medicare will no longer cover the patient. For this reason, we often recommend that our clients consider switching back to Medicare Part A and B when they need long term care.
Of course, that switch can only be made under special circumstances or during Open Enrollment. We are in the midst of Open Enrollment now which allows beneficiaries to switch between plans, add or drop Part D, move from traditional Medicare to Advantage or the reverse. There are many professionals who can help you consider your options given your specific health situation for free. Just remember you must make any changes by December 7th.