By Dr. ROBERT FREELOVE
Senior Vice President & Chief Medical Officer, Salina Regional Health Center
Every fall, seniors have the opportunity to evaluate and make important decisions about their Medicare coverage during the annual open enrollment period, which runs from October 15th to December 7th. While there are many plans to consider, your options essentially come down to two choices: Original Medicare or Medicare Advantage.
Original Medicare is a federally funded program that offers extensive access to healthcare providers across the nation. Beneficiaries can visit any doctor or hospital that accepts Medicare, ensuring that seniors can receive timely care, even in smaller or more rural communities. This flexibility can be critical, especially for those living in more rural areas where provider options are limited.
Medicare Advantage plans, on the other hand, are private insurance alternatives to Original Medicare. While they are required by law to cover all the services that traditional Medicare offers, these plans often operate within narrower networks of doctors and hospitals. Additionally, 99% of Medicare Advantage plans require prior authorization for certain services and medications, which can sometimes lead to delays in receiving necessary care.
This issue is particularly concerning for residents in rural areas. For example, Salina Regional Health Center, which serves more than 12,000 square miles of central and north central Kansas, provides critical access to healthcare in some of the state's most rural areas. Unfortunately, the restricted networks of many Medicare Advantage plans can limit access to care in these regions, disproportionately affecting the seniors who live there.
While Medicare Advantage plans may appear more affordable due to their lower premiums, it’s important to understand the full picture. These plans often come with additional costs, such as copayments, coinsurance, and deductibles. A recent Kaiser study revealed that nearly half of all Medicare Advantage enrollees pay more for a seven-day hospital stay than those covered by Original Medicare.
As we approach this year’s open enrollment, I strongly encourage seniors and their families to carefully consider their options. Contact your local healthcare providers and hospital to see how a Medicare Advantage plan might impact your access to care. Choosing the right Medicare plan is not just about finding lower premiums—it's about ensuring you have access to the healthcare you need to continue living well in north central Kansas.