SUNDANCE — With Medicare enrollment upon us, the business office at Crook County Medical Services is looking to clear up a misconception about Medicare Advantage plans.

It may not be immediately obvious, said Business Office Manager Julie Zaato, but enrolling in a Medicare Advantage plan does not mean a person has double coverage.

“What I find is that, a lot of times, people will elect for a Medicare Advantage plan, and they don’t realize that (it) replaces their Medicare,” she said. “Truly, it’s one or the other.”

Medicare Advantage plans are private insurance, rather than government run and funded.

“Claims are processed by commercial insurances that have gone through whatever steps they have to to be able to provide these types of plans,” Zaato said.

A Medicare Advantage plan may or may not work for you, she said, as it does offer different benefits and drawbacks to standard Medicare.

“I do think they are often cheaper,” she said. Patients who have enrolled in an Advantage plan have told her that the premiums are reasonable.

They can also negate the need for supplements because they will include, for example, dental and prescription coverage.

“They will offer some of those services that you don’t actually get with standard Medicare, that you would have to pay for extra coverage for,” she said.

On the other hand, Advantage plans can impact a person’s access to medical care.

“Where the mismatch happens is when you actually need in-patient care,” Zaato said.

Medicare Advantage, she explains, always requires pre-authorization, and this can lead to a delay in care.

It can take three or four days to get a patient authorized to come to Crook County Memorial Hospital from a facility further away for swing bed care, for example, while a provider cannot simply order a CAT scan or MRI without pre-approval from the insurer.

“Standard Medicare never [requires pre-authorization] — not to be admitted, not to get an MRI, none of those things,” she said.

Medicare Advantage may therefore work better for patients who are not currently likely to require intensive medical care. Perhaps even more importantly, Advantage plans limit the number of days for which someone can receive in-patient care. 

“Once you’re here, the insurance company for Medicare Advantage gets to determine when you get to go home, rather than your medical professional,” she said. “That’s one really big difference that we see here in the hospital.”

Advantage plans are also more of a burden for rural hospitals, which usually lack the manpower to go through every claim and make sure the plan is held to the same standard as Medicare.

The National Council on Aging advises anyone who has enrolled in a Medicare Advantage plan without realizing it would not provide double coverage or would otherwise prefer to enroll in standard Medicare that the Medicare Advantage Open Enrollment Period runs from Jan. 1 to March 31, during which patients may switch to a new Advantage plan or disenroll.