Time for a change...PODay 149

It's the time of the year when we Medicare patients are allowed to change plans. We can choose a traditional Medicare plan or a Medicare Advantage plan and we can choose a Medicare plan with Part D coverage. These choices can be made when we turn 65 years old, if we move, if a sponsored plan is terminated, or between October 15 and December 7. If we choose the traditional Medicare plan we may choose our own physician and hospital. If we opt for the Medicare Advantage plan we are limited to seeing only the doctors who are part of the plan and must be referred to specialists by our "plan" primary care doctor. The latter plan is less expensive so naturally there are restrictions. But the lower cost to the patient is significant and many people join an Advantage Plan.

But there can be a problem. In the Journal of the American Medical Association Dermatology it was reported that Medicare Advantage insurers overestimate how many in-network dermatologists are actually enrolled in the plan. Many of the "listed" dermatologists were dead, retired or not accepting new patients. Of 4,700 dermatologists listed as participants in various plans 45% were duplicates. More than half, 51%, were not available to see patients.

This problem is not unique to dermatologists. Many plan members have problems finding doctors who will accept them as patients. In their zeal to sell the programs the sponsors exaggerate physician membership, leaving new members struggling to find medical care after they have made the commitment to the new plans. There is a window for changing your mind. If you become disenchanted with your new plan you can disenroll between January 1 and February 14. After that, you are stuck for the rest of the year.

I love a bargain but until there is some oversight of the Advantage Plan sales people I'm sticking with traditional Medicare. I do realize there are excellent Advantage Plans that live up to their promises but it's hard for the non-medical person to know which is which.  A personal recommendation would be reassuring. When I decided to seek a second opinion about my broken shoulder I had an appointment with my primary care doctor within one day, an MRI the next day, and an appointment with a specialist orthopedic surgeon a week later. Decisions were made between each doctor and me, there was no plan administrator looking at the statistical cost effectiveness of reverse Total Shoulder
Replacement surgery and deciding if I were worth it.


http://www.youtube.com/watch?v=pl3vxEudif8&sns=em


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October - getting back to normal, November - almost there!