This fall, during open enrollment, seniors in Whatcom County can sign up for health insurance for 2020. Many options are available, and it can be confusing to sort through the choices.
If you’re interested in rehab and therapy services from Christian Health Care Center in the future, there are specific things you should know about Medicare before signing up.
How is Medicare Advantage different from Original Medicare?
There are benefits to both Original Medicare and Medicare Advantage, and you should weigh the benefits 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) and Part B (outpatient) 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 they must provide the same benefits as those offered by Original Medicare, the rules, costs and restrictions on those benefits might vary. Some Medicare Advantage plans (see all available plans here) 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 a number of different specific plans and pricing tiers. All of the options and choices can be difficult for individuals and families to navigate. It can be easy for anyone to make decisions to save money now that will cost more later or that will result in not being able to receive care at a location they want.
Medicare Advantage might not pay for your stay at CHCC
Some healthcare providers covered by Original Medicare are not available on Medicare Advantage plans. While most healthcare providers (including CHCC’s short-stay rehab) take Original Medicare, acceptance of Medicare Advantage is not as widespread.
Christian Health Care Center works with some Medicare Advantage plans, but not all. There are many different Medicare Advantage plans, and anyone on an Advantage plan other than those that are contracted with CHCC would not have coverage at our rehab facility.
What you can do: If you are making the switch to (or staying on) Medicare Advantage and want to keep open the possibility of receiving care at CHCC someday — especially if you live near Lynden or elsewhere in northern Whatcom County and want a local option — it’s important to ask the plan’s provider for what’s called an “organization determination” for care at CHCC. In an organizational determination, the Medicare Advantage plan you’re considering can give you authorization for a specific service and/or let you know how much the plan will pay. If questions still arise, reach out to the business office in our Lynden healthcare center.
If you’re expecting a hip replacement or knee surgery in the future, for example, and want an option for rehab in Lynden, you may want to ensure that CHCC is covered. If you want to ensure that you have the option of receiving local rehab care at CHCC, now’s the time to ask. Before you sign up for Medicare Advantage, have a conversation with your insurance provider about where you can receive care.