Just how good is a Medicare Advantage Plan when compared to Original Medicare? While it looks great initially because the is cost nothing, what happens when a loved one really needs care in a rehab facility? I had a client who fell and went to the hospital for care. The doctor felt he needed physical therapy and occupational therapy before returning home so he would not fall again.  However, no rehab facility would accept him on his Advantage Plan, even with doctor’s orders. And to make it worse, his insurance company, refused to cover any rehab because he hadn’t broken anything when he fell. He was in limbo for over 10 days in the hospital, arguing with his Medicare Advantage company, no facility agreeing to accept him, and the hospital refusing to discharge him home. Finally, a local rehab facility took him as a private pay patient for 3-4 days, (about $375 a day) and was able to switch him to “Original Medicare, “ not a replacement advantage plan.

If the word ADVANTAGE is on your insurance card, you are on a Medicare Replacement plan. If you are still healthy, and feel you will not need any serious care then perhaps your reasons for choosing a MAO (Medicare Advantage Organization) sounds reasonable. If the reason is purely financial you may not have a choice, but at least make sure you understand the risk.  When you need it the most, like after surgery, a fall, a major health event, you may not be able to access the care you need to make a full recovery!  Be forewarned. More and more facilities are denying accepting this type of insurance plan, and more and more MAO’s are denying coverage. According to a recent governmental report, “denials of prior authorization requests raise concerns about beneficiary access to medically necessary care.” SOURCE: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf

If you need excellent and free advice on any Medicare, Medicare Advantage Plan, or  Medicare Supplemental Plan, contact  SHINE, Seniors Helping Insurance Needs of  Elders.  Visit their website at. https://floridashine.org/ or call 1-800-963-5337

“The SHINE (Serving Health Insurance Needs of Elders) Program provides health insurance information and free, unbiased, and confidential counseling assistance to Medicare beneficiaries, their families, and caregivers.”

Let me know if this information was helpful!