By Myron D. Lewis, FACHE
President & Chief Executive Officer, Blanchard Valley Health System

Medicare open enrollment season is upon us, and I encourage eligible community members (generally age 65 or over) to examine their Medicare health coverage plans between now and the December 7 deadline. The choice comes down to traditional Medicare or Medicare Advantage, and the difference may surprise you. Medicare Advantage might sound appealing due to its name, the positive portrayal on high-dollar commercials, and the promise to cover all aspects of care, including dental, vision, and prescriptions. “Advantage” does not mean the plan will be better for you or your health care provider, as these plans come with significant risk. ▶︎

When you choose an Advantage plan, you give up traditional Medicare coverage for an option that is increasingly denying a large percentage of claims. Over the last few years, we have had numerous patients share that they are struggling to receive the follow-up care prescribed by their physicians. As one example, we have seen that Medicare Advantage plans are delaying or denying admission and care to facilities such as nursing homes and rehabilitation centers. In reviewing what is happening, our physicians are noting that the prior authorization process used by Advantage plans often delays care for our patients. You can read more about the risks of the Medicare Advantage plans from our neighbors at the Kentucky Hospital Association by visiting kyha.com/medicare-advantage.

Medicare Advantage is increasingly dominated by large, for-profit insurance companies that are accountable to their shareholders – not to patients or hospitals. As a result, they are continually finding loopholes in federal regulations to capitalize on your tax dollars. Additionally, the delay and denial process is driving up administrative costs for local providers.

We have had situations in which patients must travel long distances from their home communities for a provider their Medicare Advantage plan will cover. They may also find that their Advantage plans have changed the formulary for medications they cover, causing confusion for patients and the doctors who care for them.

At Blanchard Valley Health System, we are working to help the community navigate their insurance claims, as Medicare Advantage companies identify creative ways to avoid delivering or making payment on prescribed services. Our country’s health care system is already too complex, and Medicare Advantage plans are making it even more complex for both patients and health care providers.

There is another solution, and it is not the “Advantage” you see advertised. Choosing traditional Medicare over Medicare Advantage can lead to better outcomes for patients and health care providers. Consumer Reports analysis of Medicare options says more people in rural areas like ours are going back to traditional Medicare because of the issues highlighted.

While many factors may influence your plan choice, I urge you to consider the impact on your access to health care, and on local community health care organizations, when you make your decision. We know having to evaluate your coverage each year is difficult and time-consuming for you and your family. Resources for comparing plans are available through the Ohio Department of Insurance at insurance.ohio.gov/medicare.

The open enrollment period is also a great time to select a primary care provider or make a specialty appointment. You can call 419.422.APPT to become one of more than 4,000 patients we care for every day. We are working hard to bring you the care you need, and to ensure your care is covered by your Medicare plan.