ROBERT PIERCE
• Leader & Times
Open enrollment for Medicare for 2025 is currently under way and will run through Dec. 7, and while enrolling in Medicare is encouraged by many in the medical profession, officials with Liberal’s Southwest Medical Center are advising caution when choosing a plan.
SWMC CEO Amber Williams said hospital leaders want patients to fully understand the benefits offered by traditional Medicare plans Part A and Part B and those offered by Part C, more commonly known as Medicare Advantage.
“A lot of people don’t know the nuts and bolts of it when you get down into the nitty gritty,” she said. “When they offer the Advantage plan, a lot of them offer a premium that’s lower, and they throw stuff in there like a free gym membership. When you get down into it, financially, it’s not beneficial for Medicare patients to go with the Advantage.”
Williams said there are several reasons for this.
“Traditional Medicare Part A is free,” she said. “Part B, a lot of it’s based on your income, and they withhold usually from your Social Security payment you get each month. You get a perk, a secondary insurance to cover after Medicare, and you’re in pretty good shape.”
Another benefit to traditional Medicare, Williams said, is the flexibility it offers both with doctors and specialists and its acceptance in many places.
“It follows you anywhere,” she said. “If you get Medicare in Kansas and you decide to retire in Florida, that follows you. The claims may have to be sent somewhere else, but you’ve got your traditional Medicare. The Advantage plan doesn’t do that. With traditional Medicare, you can see pretty much anyone you want to.”
With Advantage too, Williams said Medicare will assign a provider, and patients have to go through a referral process to be seen by a specialist.
“Almost every service offered by a provider, if you have a Medicare Advantage plan, has to have an authorization before it can be done,” she said.
Yearly, Medicare has an open enrollment from mid-October to early December, and those who have signed up with Advantage before and are dissatisfied with that plan can switch back to traditional Medicare easily.
“It can be as easy as I’m on traditional, I want to stay on traditional, or you can say, ‘I’m on an Advantage plan, I want to switch,’” Williams said. “You can only do that during open enrollment or something they would call a special event. A spouse passes away, or you get married. Those of the type of events that would allow you to change other than the open enrollment time, but open enrollment is when you pick which Medicare you’re going to be on.”
Williams said the limited amount of specialists in a rural area such as Southwest Kansas already make it difficult to be seen by a specialist, and Medicare Advantage adds to that difficulty.
“They have to be referred,” she said. “They think by getting on the Advantage plan, it’s cheaper, and it is. A lot of the Advantage plans are cheaper than traditional Medicare, but there’s also those costs you don’t think about – out of pocket. A lot of stuff, they deny, so if you want it done, you’re paying out of pocket.”
Williams said with Medicare not approving a medical procedures, that denial too will be done by any supplemental insurances as well.
“If Medicare doesn’t approve it, your secondary’s not going to approve it either,” she said. “They come out here in the rural areas. A lot of people don’t accept the Advantage plan, so they bill it out of network, which is an increased cost to the insured.”
In short, Williams said Medicare is basically low-cost insurance with little benefits.
“A lot of people focus on the first one – low price,” she said. “They don’t see the limited benefits you’re facing by getting that Advantage plan.”
Williams said she attended a recent program hosted by the Kansas Hospital Association when she learned 3.4 million prior medical procedures nationwide were denied by Medicare Advantage. This amounted to 8 percent of people needing treatment not getting it because Medicare Advantage would not pay for it.
“That leaves you a Medicare patient already on a limited income having to come up with money to pay for a test they need to have done,” she said.
Williams said she feels it does not matter whether a patient’s condition is pre-existing or not.
“Someone at Medicare age and eligible should go with a traditional plan,” she said. “At first, they may think it’s more of a cost than the Advantage plan, which it is, but when you tally it up at the end of a year and you see how much stuff they won’t approve, the extra out of pocket you didn’t expect, you’re going to find out the Advantage plan has cost you a lot more money than the traditional Medicare has.”
Though she recommends traditional Medicare, Williams did advise not taking her word for it.
“They need to go out, and they need to do the research,” she said. “The Kansas Hospital Association has a Web site. We also have the information up here, and we’re willing to give it to anybody who would like to get a comparison of traditional versus managed care so they can see in black and white the difference between the two plans.”
