Working in the health care profession for more than 35 years, including 20 beautiful years for the federal government program Medicare, I have seen so much confusion in elder patients.
This is particularly important at times when they have the option to just stay with the traditional Medicare fee for service or choose a Medicare Advantage Private Fee for Service program. These plans are supposed to be better than the traditional old Medicare, since they offer an additional prescription drug plan. How good is this plan for you?
It is very sad that some insurance agents misrepresent themselves to Medicare recipients, confuse them even more and before you know it, the "free lunch'' they invited you to share was not free.
When attending a "free lunch'' to learn about these new products, I would suggest you do not sign any papers, and do not provide your Social Security information or other personal information to the insurance representative.
Enjoy your free meal, listen to the program, ask many questions, take it home to discuss with family members, neighbors or anyone who has some knowledge about these plans. Once you have determined if it is a good plan for you, then contact the insurance agent to sign you on.
Some questions to ask are:
1. "How do I know this is the best plan for me?''
Ask to see "Evidence of Coverage" booklets. This will allow you to compare the traditional Medicare vs. the new plan.
2. "If I decide to switch, am I still eligible for Medicare?''
Yes, you are. You have to be active in the Medicare program in order to join one of these plans. Place your red, white and blue Medicare card in a safe place; do not carry that with you to the doctor. Use your new insurance card; you will only need that one card.
3. "What if my doctor is not in the plan? They say I can see anyone who takes Medicare.''
Yes and no. Many doctors would like to have a contract with that insurance company, the same way they have contracted with CMS (Center for Medicare Services). Only doctors in the plan can bill the insurance company directly, but they have to follow the company's rules and guidelines. Many of these plans have different types of copayments and/or deductibles. So, when they say they work like Medicare, it is not always so. They do follow the Medicare fee schedule, and pay your doctor what they have agreed on. Some plans require you to stay in the network, the same with using in-network pharmacies.
4. "How do I know if my prescription is covered?''
Ask for the list of prescription (formula) drugs from the insurance company. You may get this from their Web site. Compare your drugs with what they cover and see if this plan is right for you.
5. "Does this plan need pre-authorizations?''
You need to know this. Find out if you will be responsible for any testing not preauthorized, or if the plan is free of authorization.
You need to ask yourself, is the cash-back offer a good deal? Am I really saving money? If the answer is yes, you have a good deal. If not, reconsider different plans.
Remember, this is your health, your choice, your decision. Do not let a free lunch change your lifestyle. Look at the whole picture. Compare apples to oranges and see what is best for you.
Once you sign on to one of these plans, you no longer will have Medicare. But it is still there for you as a backup once your year is over and it is time to re-enroll again.
If you believe you were forced to sign into a program, call the Medicare hotline. They can help you switch back, but only if there was fraud or deceit.
Diana C. Brijbag is a certified medical manager, a certified compliance professional and the office manager of a medical practice. She lives in Brooksville. Guest columnists write their own views on subjects they choose, and do not necessarily reflect the opinions of this newspaper.