This fall, during open enrollment, seniors in Whatcom County can sign up for health insurance for the coming year. Many options are available, and it can be confusing to sort through the choices.
Some plans are more expensive than others, and it’s for reasons of cost that many people end up choosing Medicare Advantage plans. If you’re interested in rehab and therapy services from Christian Health Care Center in the future, however, there are some things you should know before signing up.
What is Medicare Advantage, and how is it different from Original Medicare?
There are benefits to both Original Medicare and Medicare Advantage, and you should weigh them carefully and understand what you are getting. Medicare.gov provides an online tool to help you estimate out-of-pocket costs.
Original Medicare is the health insurance program operated directly by the U.S. federal government. Benefits to Original Medicare, which consists of Part A (inpatient hospital insurance) and Part B (outpatient medical insurance) coverage, include a wider array of provider choices and a lack of need for referrals before receiving care.
Medicare Advantage (often referred to as Part C) plans are different.
They’re plans sold by private insurance companies – such as Kaiser Permanente, Humana, UnitedHealthcare and Premera Blue Cross Medicare Advantage – that contract with the government to provide Medicare services to clients. Medicare pays these companies to provide Medicare services to you. Because they’re private plans offered by different organizations, not all Medicare Advantage plans are the same.
While Medicare Advantage plans provide the same benefits as those offered by Original Medicare, rules, costs and restrictions might vary. Some Medicare Advantage plans also cover additional services not covered by Original Medicare, such as dental, vision and hearing. Plus, there’s a cap on out-of-pocket expenses.
There are several types of Medicare Advantage plans, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and others. Within each of those categories are various specific plans and pricing tiers.
The many options and choices can be difficult for individuals and families to navigate. In some cases, decisions made to save money today might result in not being able to receive care at desired locations.
Medicare Advantage might not pay for your stay at CHCC
Some health care providers covered by Original Medicare are not available on Medicare Advantage plans. While most health care providers (including CHCC’s short-stay rehab) take Original Medicare, acceptance of Medicare Advantage is not as widespread. There are many Medicare Advantage plans, and some do not offer coverage at CHCC’s rehab facility.
HMO and PPO plans are managed care plans, which means that choices are generally restricted to health care providers that are within a specific plan’s network. Generally, HMO plans require you to receive services from network providers, while PPO plans will charge higher prices for care from out-of-network providers. CHCC doesn’t contract with all managed care plans and thus is not considered an in-network provider on those plans. If you have one of those plans, care at CHCC is not guaranteed.
Here’s what you can do if you want to be covered at CHCC:
The truth is that no coverage is 100% guaranteed. But if you want to receive care at CHCC — helpful if you live near Lynden or elsewhere in northern Whatcom County and want a local option — your best bet is to choose Original Medicare.
However, if you want a Medicare Advantage plan, you’ll want to ask the plan’s provider for an “organization determination” for care at CHCC. In an organizational determination, the Medicare Advantage plan you’re considering can let you know whether a specific service — rehab after a hip replacement or knee surgery, for example — is generally covered at CHCC.
Keep in mind, though, that it’s not until you actually use the benefit that the plan will decide how much it will pay for the service.
For more information on how CHCC works with Medicare, please visit https://chcclynden.org/contact-us/payments-and-business/. To talk with an expert about Medicare choices, you might consider contacting the Statewide Health Insurance Benefits Advisors program provided by the state Office of the Insurance Commissioner.