Friday, January 12, 2018

Half Empty or Half Full?

You are probably familiar with the phrase "Is the glass half empty or half full?". A popular meme says, the problem is obvious. You need a smaller glass. Better idea, more wine.

This may be the solution when you are talking about wine. But how about health care?

No, not health insurance. Health CARE.

A recent Kaiser Foundation report addressed the issue of "robust physician networks" in popular Medicare Advantage plans. (Full report here).

Many people are confused about Medicare Advantage plans, especially those that do not charge a premium. (Free insurance. How can they do that?).

Excellent and logical question and one that comes up quite a bit. Most folks on Medicare are smart enough to know if someone offers you a product or service at no charge there must be strings attached.

But the $0 premium plans are a marketing gimmick by the carriers, not something baked into Medicare rules.

That is a discussion for another day.

Regarding doctor networks and Medicare Advantage plan consumers are once again faced with the question. If I like my doctor can I keep my doctor?

The answer is "yes".

Advantage plans do not forbid you from seeing certain doctors. You are free to use any doctor you wish . . . as long as you are willing to pay for that privilege.

From the KFF report (linked above):

 As of 2017, 19 million of the 58 million people on Medicare (33%) are enrolled in a Medicare Advantage plan, yet little is known about their provider networks.

"Little is known about provider networks". I wonder how many of those 19M people really understand networks and what that means. In particular, what happens if you are in treatment at the end of the calendar year and your doctor(s), hospital(s) and clinic(s) are not in network the following year?

According to Kaiser, 78% of Advantage plans did not include all doctors who practiced in the service area. On average, less than half (46% per the survey) of physicians did not participate in Advantage plans. Some plans included 60% of physicians who practiced in a particular county while other plans had less than 10% of doctors participating.

The report included the following eye openers:

  • 20% of plans had fewer than 5 thoracic surgeons
  • 18% of plans had less than 5 neurosurgeons
  • 16% of plans had fewer than 5 radiation oncologists
Remember, you are free to use any doctor you wish, including your own, but using someone that is not on the approved list can be harmful to your wallet.

And some doctors, including your regular one, may refuse to see you if you have an Advantage plan.

The size and composition of Medicare Advantage provider networks is likely to be particularly important to enrollees when they have an unforeseen medical event or serious illness. However, accessing the information may not be easy for users, and comparing networks could be especially challenging. Beneficiaries could unwittingly face significant costs if they accidentally go out-of-network. Differences across plans, including provider networks, pose challenges for Medicare beneficiaries in choosing among plans and in seeking care

If you opt for a Medicare Advantage plan, make sure you understand the rules and are willing to play by them. Otherwise you may be in for a rather costly surprise.

You can pick a plan with a broad network and fewer restrictions for using non-par providers, but you can expect to pay more.

Higher premiums. Higher copay's. Higher deductibles. Higher out of pocket limits.

And how DO they offer plans that don't charge a premium?

Maybe I will address that next time . . .

#MedicareAdvantage #NarrowNetworks #HalfEmptyHalfFull

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