Medicare Advantage Plans- Are They Really Worth It? What You Need to Know- Part 2.

A few weeks ago, I wrote a blog about Medicare Advantage plans. I gave some pros and cons to these plans, and an example of someone who switched and regretted it…

In my honest opinion, Medicare Advantage plans are NOT worth it, but I’ll give you more information and let you decide yourself.

I’ll give you the pros and cons once more, that way you can see them again, as well as another example of someone who switched- and unfortunately also came to regret that decision.

Pros  

  • Your advantage plan can be a “one-stop” shop for your prescription drug coverage and health needs  
  • Many plans include dental and hearing  
  • Some plans can cost $0 a month  
  • Some plans include gym discounts  

Cons  

  • If you change to an advantage plan, sometimes some services aren’t covered (for example, physical therapy)  
  • The coverage for some services and procedures may require a doctor’s referral and plan authorizations  
  • You typically don’t receive nationwide coverage  

Many people think want straight-forward answer about Advantage plans, but sometimes it isn’t as straight forward as asking the right questions. For example, many of our clients will need or might need home health services. Jane was one of those clients. She lived in one of the senior living facilities that we work with, and she often would need home health therapy and nursing for various health issues. Her family had decided to switch to an Advantage plan with Humana. Her daughter was so great in helping her ask all the questions she needed. She would be able to keep her doctor, and they told her “yes, the plan covers home health therapy and nursing”, and the best part was she would save on monthly medication cost. So, they made the switch.

Everything was going well until she was hospitalized due to a UTI, and had a fall and scraped up her arm. She needed home health nursing and therapy to get her back to her spunky, fun self. She was feeling confident that she would be back to her normal self in a month or two, however, the issue surfaced when her insurance said they would only approve three nursing visits and five therapy visits. The nurse had recommended six nursing visits to make sure the large gash on her arm was treated with the proper wound care, and we all know it take more than five visits of therapy to address the strength and balance problems that she had following the hospital stay and her fall. She was very upset. The home health agency and her doctor fought for more approved visits but ultimately failed. Jane was now faced with the decision to pay out of pocket for her therapy or accept that she wouldn’t get back to her normal self. It was a terrible situation. She felt cheated and misled. She would now have to wait until next year during open enrollment before switching plans. 

We never want anyone to EVER have to deal with this. Jane had to deal with this frustration, but you don’t!

Are you struggling with pain right now, and have more questions about the pros/cons of a Medicare Advantage plan? Call our clinic at 512-730-0231 to speak with a Physical Therapist about how we can help YOU TOO achieve your goal and live a healthier, more active, and independent life!