Many seniors sign up for Medicare Part A and B, better known as traditional Medicare, when they turn 65. Most are still healthy and looking forward to an active retirement that may include travel and time with family. They like the flexibility of traditional Medicare. These seniors may see any provider or hospital that takes Medicare, no matter where they are in the United States. Because they are relatively healthy, they generally don’t pay attention to what their Medicare plan covers, until they need to use it.
Needs evolve with age
Five or 10 years later, however, they may be diagnosed with a chronic condition, like diabetes, kidney disease or a heart condition. They start seeing more specialists and medications become increasingly expensive.
While things are looking better in 2019, Medicare Part D participants will still have to pay 25 percent of their prescription costs after they have reached their prescribed threshold. For someone with chronic obstructive pulmonary disease, better known as COPD, the monthly costs for medication can exceed $800. Once seniors fall into the coverage gap, also known as the “donut hole,” they are paying more than $200 per month out of pocket until they reach their plan’s catastrophic maximum.
“For seniors on a fixed income, $200 per month may require a choice between their prescriptions and their utility bills or groceries,” notes Dr. Roopa Dani of P3 Medical Group’s West Sunset Clinic. “All too often, we see patients who have stopped taking their medications. Their conditions have significantly worsened, and, in some cases, they require hospitalization.”
This lack of coverage negatively affects the health of many seniors.
Falling through the cracks
When chronic conditions set in, many seniors appreciate their doctors addressing their ailments, but something is often missing. “My husband and I are more than our conditions,” says Bonnie Zavsza, who sees Carolyn Dechaine (PA-C) at P3’s Town Center Clinic. “I have multiple specialists helping us with various health issues, we followed Carolyn to her new practice because she is so kind and makes sure we’re treated as whole people.”
This is often the case with the fee-for-service approach of traditional Medicare. Medical providers are only compensated for the patient’s office visit, creating little incentive for primary care providers and specialists to see the patient holistically and thoroughly coordinate patient care. As a result, it’s easy for seniors to skip follow-up tests and appointments. They continue to spiral towards expensive hospitalization when they could be on an upward trajectory with wellness-focused care.
Taking advantage of Medicare Advantage
There are alternatives available that can help expand coverage and get seniors the comprehensive and coordinated care they need. Seniors with traditional Medicare can add supplemental coverage to their existing plan which can help them cover costs of Medicare-authorized expenses such as co-pays and deductibles.
Medicare-eligible patients can also opt for a Medicare Advantage (MA) plan. An MA plan covers all the traditional Medicare benefits, including hospitalization, dwoctor visits, and medical equipment. MA plans also offer additional benefits like dental and vision coverage— critical aspects of maintaining one’s overall health. These plans can also include transportation services to helps seniors run errands and get to medical visits. Furthermore, these plans may cover grocery or home meal delivery after hospitalization.
Dani recommends patients consider MA plans during the Medicare Annual Election period, which runs through Dec. 7, 2018. “The best part of having a Medicare Advantage plan is that it helps providers like me better coordinate your care. Under this plan, healthcare providers are better able to focus on keeping their patients happy and healthy.”
After realizing that she needed to make a change to her Medicare Advantage plan to keep her provider, she reached out to her broker and discovered the two new plans in the market include P3 Nevada (and Carolyn) in their network. “We’re so happy to be able to stay with the provider we love and it we’ll even save money in the long run.”