The Oklahoma Hospital Association published a free resource for Oklahoma seniors to navigate choosing a Medicare plan during open enrollment, which goes through Dec. 7.
Rich Rasmussen, the association’s president, said the idea came from his time spent on the road during his first year talking with members, employees, trustees and patients.
“We want to make sure that our patients get the best care at the best setting that keeps them closest to home. Because the medical evidence will show that when somebody is being cared for and surrounded by family members and support groups, they recover much faster, and the recovery is with fewer complications,” Rasmussen said. “... We just want to make sure that they're empowered with information on the front end.”
Oklahomans can choose from three options:
- Original Medicare: This is administered by the Centers for Medicare and Medicaid Services and covers hospital care, doctor appointments and prescription care in different parts. It pays physicians, hospitals and other facilities based on established payment systems.
- Medicare Advantage: This is offered by Medicare-approved private insurance companies that contract with Medicare. It bundles hospital care, doctor appointments and, sometimes, prescription care. They offer some benefits not covered by Original Medicare, like vision, hearing and dental services.
- Medicare Advantage, sponsored by hospitals: Hospitals partner with insurance companies to create a network for their hospital services and providers that is sold directly to consumers.
The association’s website, MedicareDisadvantaged.org, outlines the differences between the plans, offers printouts for providers to help educate patients and highlights considerations for those in rural Oklahoma with less access to care.
“You have three options out there as a senior, and each senior will have to decide — talking to their physician, talking to their spouse or partner, or their family members — what works best for them,” Rasmussen said. “And then we lay out for them some considerations.”
Rasmussen said the common thread in conversations he had across the state that led to the need for this website were challenges with Medicare Advantage plans. He said this included limited provider networks and delays to patient care through more prior authorizations, which are less common for Traditional Medicare.
“What we want to make sure is that before they take [a call from a salesperson], they have an opportunity to have some education, so they're not being potentially encouraged or directed into a health plan that may not offer all that is cracked up to be. … You should be asking, ‘Is my local hospital in the plan? Is my physician in the plan? You provide dental benefits, but is there a dentist in my community? You promise eye services. Is there an optometrist in my community?’” Rasmussen said.
The association’s website points to a recent U.S. Senate subcommittee report, which highlighted findings on how the nation’s largest Medicare Advantage insurers denied requests for post-acute care at higher rates than other types of care. Rasmussen, who helps his 95-year-old mother navigate Medicare enrollment, said these differences are important for Oklahomans to know.
“This is our commitment to our to our senior patients. They are the elders of our state, and we want to make sure that everything that we do, we ensure that those that are vulnerable, that we surround them with additional support, and then they get to make the decision ultimately,” Rasmussen said. “But we just don't want to see seniors that are vulnerable or left hanging with a denial or delay that could impact their health outcomes.”
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