By Woodrow Wilcox
On July 16, 2019, I helped a sweet but confused widow from Portage, Indiana. She thought that Medicare would pay for almost everything. But, she got and paid a bill over $8,000 for care for her late husband.
The widow was confused about the policy that her late husband had. Technically, he did not have “Medicare”. He did not have a Medicare supplement insurance policy either. His former employer put him on a “Medicare replacement” or Medicare Advantage plan. The two systems work differently.
When a senior citizen has Medicare as the primary insurer and a Medicare supplement policy for the secondary insurer, medical service providers (hospitals, doctors, laboratories) file the claim with Medicare. Medicare determines what is or is not eligible for coverage and then sends the claim report to the private supplement insurance.
When a senior citizen has a Medicare Advantage plan, the claim is filed with the private insurance company. The insurance company determines what should be covered according to the rules of Medicare. With these plans, medical service providers file the claims directly to the private insurance company and not to Medicare.
A big difference between the two systems is that there are co-pays in the Medicare Advantage plans. Also, senior citizens must use doctors that are within the plan’s network of medical service providers. Seniors can change their Medicare Advantage plan only during the OPEN ENROLLMENT PERIOD which is in the last few weeks of the year. Medicare supplement plans can be changed at any time of year.
If a senior goes to a hospital that is in the Medicare Advantage network, but a doctor who not in the network gives service to the senior citizen, the patient will get a big and unexpected medical bill.
Senior citizens need help with deciding whether to use Medicare and a Medicare supplement plan or use a Medicare Advantage plan. Our agency consults seniors about this all the time. It is one of the reasons that our agency has grown to be the largest senior citizen oriented insurance agency in northwest Indiana.
Also, our agency has gained a reputation for giving our clients great customer service. The Medicare system is far from perfect. When there are problems with medical bills, our clients know that they can get help from our agency FREE OF CHARGE.
Written on July 16, 2019 by Woodrow Wilcox