Medicare Open Enrollment Time

Key points to consider when making your selection between traditional Medicare & Managed Medicare plans – and just how does inpatient rehab fit in?

Ah, fall is in the air. Brisk temperatures, the crunch of leaves underfoot, and every other television commercial touting the benefits of Managed Medicare. It is open season – that time from October 15-December 7 – when Medicare enrollees can change their health insurance plans. Many seniors find this a confusing and daunting task.

The Managed Medicare plans (also referred to as “Medicare Part C”) are usually less expensive than traditional Medicare Part B & D. Some very basic plans are available at no cost, with Medicare paying the insurer. They include not only the (free) Medicare Part A hospitalization and Nursing Home benefit, but also the outpatient and drug benefits, that beneficiaries would otherwise have deducted from their Social Security check (Part D payments may alternatively be paid directly to a Part D insurance plan). In addition to saving money, these plans also offer the convenience of a one-stop-shop, with all health services coordinated through one payor.

Sound too good to be true? Well, it may be, depending on the person’s health and use of services throughout the year. And most of us don’t have a crystal ball to forecast that! In general, managed plans work out well for people who are in good health and utilize mostly preventive medicine services. Ever wonder why the commercials show attractive, fit, youthful-looking retirees swimming, playing in garage bands, or golfing? This demographic, not the person with the walker, wheelchair or oxygen tank, is the target. Consumers who require hospitalization, or inpatient rehabilitation, may find they are authorized for fewer hospital days than if they had regular Medicare, and are denied acute rehabilitation.

Almost every day, at Helen Hayes, I am asked by a prospective patient or their family member, why they can’t come to our acute inpatient rehab program following say a stroke, hip fracture or joint replacement. I explain to them that while traditional Medicare would have paid for their stay, the managed plan considers their condition “subacute,” the level of medical, nursing, and therapy services delivered in nursing homes. Case managers for the Managed Medicare plan would only authorize payment for a nursing home (also called a Skilled Nursing Facility).

So, as you sit before your roaring fire this November, all snug and warm, with visions of Medicare plans dancing in your head, consider the following questions:
• Can I afford to pay a Part B premium ($104.90 per month for individuals earning less than $85,000 a year or $170,000 for married couples)?
• Do I have funds or additional insurance to cover Medicare deductibles and 20% Part B co-pays?
• Can I afford Part D coverage?
• How does the cost of a Managed Medicare plan compare to what I would pay for the traditional Medicare Part B & D? (Medicare Part A is free.)
• Are my doctors and preferred hospitals on the managed plan?
• Does the plan’s prescription coverage match the drugs I am currently taking?
• Do I anticipate needing hospitalization and inpatient rehabilitation this year?

It’s a lot to think about, but making the choice that is right for you is important and may have a lasting impact on your health and your life.

-Nancy Ferrato, RN
Director of Utilization