Understanding The Basics of Medicare Options For 2019

Medicare beneficiaries have until December 7, 2018, to make changes to their Medicare supplements or plans, if desired, during this open enrollment period for 2019. Here is a brief summary analysis of some basic differences between Traditional Medicare and a Managed Care Product (also known as Part C, or a Medicare Advantage Plan). Once you are armed with information, you can decide whether a Managed Care Product or Traditional Medicare is right for you.

Analysis: Managed Care Products (MCP) or Traditional Medicare

A Managed Care Product is NOT a Medicare Supplement Plan (or Medigap plan) that you purchase in addition to Traditional Medicare. Instead, Managed Care Products, known as a Part C plan or Medicare Advantage Plan, replace Traditional Medicare by managing your Medicare benefit. Cost savings by Managed Care Products are realized through limiting your benefits to a network of preferred providers in your geographic region. It is advisable to ask to see your preferred provider directory for any Managed Care Product you are considering.

One of the main attractions of a Managed Care Product is simplicity. Managed Care Products can manage your medical, hearing, vision, prescription drug coverage, etc., all as part of one product. With Traditional Medicare it is recommended that you purchase a supplemental plan and a prescription drug plan, which both require monthly premiums.

One of the main attractions of Traditional Medicare is that it is a lot less restrictive than a Managed Care Product. You can get covered care nationwide with any physician or provider that accepts Medicare. With a Managed Care Product, you must stay within your network of preferred providers. A Managed Care Product requires a referral to see a specialist, and requires pre-certification for certain treatments. With Traditional Medicare, there is no referral needed to see a specialist and no pre-certification is needed for treatment.

As it pertains to the Medicare benefits for a short-term stay in a rehabilitation center like Fair Haven in Birmingham, AL, after an accident, surgery, illness or injury, Traditional Medicare requires a 3-night qualified inpatient hospital stay in order to engage benefits. A Managed Care Product may not require a 3-night qualified hospital inpatient stay to engage short-term stay benefits in a rehabilitation center.

As you can see, there are a number of reasons why Medicare beneficiaries need to review their coverage each year and make adjustments accordingly. As it pertains to enrollment trends in 2017 in a Managed Care Product, here are the numbers:
Nationwide – 33% of Medicare beneficiaries are enrolled in Managed Care Product, with anticipated growth rising to 41% by 2027 (see Henry J. Keiser Family Foundation Article June 2017)* In Alabama, 36% are enrolled in Managed Care Product and 64% have Traditional Medicare. In Jefferson County, 51% are enrolled in a Managed Care Product and 49% have Traditional Medicare.

For more information about life at Fair Haven, including details on our how to make Fair Haven your or your loved one’s new home, contact our admissions team at 205-956-4150, or send an email to Traci Kennedy at tkennedy@fairhavenbirmingham.org.

Share This