Mitch Messer
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By Mitch Messer | Archwell Health
Navigating health care is no easy task for many seniors, who want stability in their health plan and doctor’s office to ensure they can afford necessary medical care and have access to quality care.
Medicare is complex and changes occur annually. Here are some answers to common concerns expressed by Arizona seniors and caregivers.
Understanding Medicare plans
Medicare has four parts: Part A covers hospital stays. Part B covers doctor visits and other services such as overnight stays at the hospital. Together, Parts A and B comprise what’s known as original Medicare. Part C, called Medicare Advantage, is an alternative to original Medicare. Part D covers prescription drugs.
Under Medicare Advantage, members can choose a Part C plan that is best for them. For example, if they have chronic conditions or have the need for regular prescription drugs, they can work with their primary care doctor and care team to determine a tailored plan to ensure their needs are covered.
Medicare Advantage also may include extra coverage for vision and dental care. Everything is covered by a single health plan and members may receive extra perks such as gym membership, funds for healthy groceries and medical equipment. The challenge to Medicare Advantage is that members must stay within the plan’s provider network to keep costs down.
While original Medicare has advantages such as getting care from any doctor or hospital, premiums may be higher and it is up to the member to keep track of several policies.
Deciding on a Medicare plan and provider
An event that frequently triggers the need to assess Medicare plans is when a member’s favorite doctor or health system gets dropped by their current Medicare plan. This is an excellent time to consider switching to a new provider or new health care system that is more convenient or has specialty care that address the patient’s individual needs.
It’s also a good time to consider changing to a health care provider that provides what is called value-based care. Seniors in particular find many upsides to this type of practice because doctors who practice value-based care are rewarded by health outcomes rather than a fee for each service.
When a doctor has fewer patients to see, they can spend more time each to really understand and get to know their patients and their needs. Another benefit of value-based care, like that provided by ArchWell Health, is that patients have a dedicated care team who are focused on personalized care for each member helping to navigate your health care coverage, specialists for your conditions and any procedures you need.
When to make a change
While the Medicare Annual Enrollment period runs from Oct. 15 to Dec. 7, seniors should start considering questions they’re going to ask when they assess personal health needs and preferences and decide what plan is best for them. Questions to consider are:
• Do you like your current doctor or feel like you have good providers to choose from?
• Do your out-of-pocket health costs beyond your insurance premium fit within your budget?
• Are you getting the appropriate coverage out of the original Medicare plan or would Medicare Advantage provide the tailored coverage you need?
• Are you finding it difficult to navigate your policies, premiums, specialist visits, tests and procedures?
Navigating uncertainty
There are many unknowns around talks of cuts in Medicare and increased costs of prescriptions. While it is natural for those on a fixed income to have concerns, an involved care team can help seniors find drug discounts and keep them informed.
Patients also may be hearing about a focus on cutting waste and fraud within Medicare. While this news may cause uncertainty, done correctly, these regulatory practices can lead to more efficient healthcare operations, cost reduction and improved outcomes for seniors.
It is more important than ever for seniors to have a strong relationship with their primary care provider and trusted advisers to navigate any changes to their insurance. Seniors and those who care for them should take the time to find a Medicare plan and care that helps them enjoy doing the things they love while contributing to the overall health of our communities.
Editor’s note: Mitch Messer is the regional growth director for ArchWell Health, which has locations in Apache Junction, Mesa, Peoria, Phoenix, Sun City and Surprise. Please send your comments to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.
