Annually, from October 15 – December 7, Medicare holds what is known as “Open Enrollment”. During Open Enrollment, you are able to switch from Traditional Medicare to an Advantage Medicare Plan, from one Advantage Medicare Plan to another, as well as make changes to your Medicare Part D plan which is your Prescription Plan.
As a Medical Social Worker and Care Transitions Manager, I have received many questions on what are the differences between Traditional Medicare and Advantage Medicare Plans.
First and foremost, knowledge and education, along with understanding your benefits is key to managing your Healthcare. Before signing up for an Advantage Medicare and Medicare Part D Plan please review your policy benefits in detail and sign up for the insurance that best fits your Healthcare Needs.
Traditional Medicare is available to all Americans 65 years or older who have worked and paid into Social Security. With Traditional Medicare you will have a Red, White and Blue insurance Card with your Social Security number and a letter A. However if you receive your Medicare Benefits through your spouse it maybe a different number with a different letter.
With Traditional Medicare you as member can choose your own Doctor and Healthcare care plan. There are No Referrals, No Pre-Authorizations, No Hidden Cost and
No Restrictions. When choosing Traditional Medicare you will also need to choose a Supplemental Plan along with Medicare Part D for your prescriptions.
Advantage Medicare is available to all members who have Traditional Medicare. Examples of Advantage Medicare Plans are Humana, Care Improvements Plan, and HealthSpring. These Advantage Medicare Plans essentially “Manage” your Traditional Medicare. The Advantage Medicare Plan choses your Healthcare Care Plan based on the Medical Necessity and the Healthcare Plan’s benefits and approval. The Advantage Medicare also includes your Medicare Part D plan and Supplemental Plan. The Insurance will offer “one stop shop” for Medicare. The Advantage Medicare may have Restricted Physician Referrals, Upfront CoPays for Hospitalization, require Pre-Authorizations and Limited Coverage.
Choosing a Healthcare Plan can be confusing. It is important to understand your Healthcare plan and your Healthcare needs. As a Medical Social Worker, Piece by Piece Care Management is available to assist you in understanding your Healthcare needs and help you choose a Healthcare Plan that best fits you. We look forward to hearing from you.
Editor’s Note: Submitted by Christina Curtis, LBSW, Care Manager at Piece by Piece Care Management, LLC. Christina may be reached at 469-631-5110 or www.piecebypiececaremanagement.com