Medicare and Medicare Advantage can feel overwhelming to navigate. While the monthly premium for a Medicare Advantage plan might be lower, if you get sick, need to be hospitalized, have surgery, or require specialized care, you may end up paying more compared to Original Medicare with a supplement.
Unlike Original Medicare, which is widely accepted, Medicare Advantage plans usually work in a narrow network, with a limited number of specialists. Medicare Advantage plans direct you to only those doctors they have contracts with. These specialists may not be your first choice, or your doctor’s first choice, and may require you to travel significant distances for care that is available locally.
Another difference is that Original Medicare rarely requires prior authorization for services. With Medicare Advantage plans, the insurance company often requires approval for care before it can be scheduled. Kittitas Valley Healthcare (KVH), and many other healthcare providers, have found it difficult to get these approvals from the insurance company. Your care has a higher chance of being delayed or even denied, with Medicare Advantage. A 2022 report from the U.S. Department of Health and Human Services Office of Inspector General (OIG, 2022) found that many Medicare Advantage plans denied necessary medical services that should be covered under Medicare rules.
Finally, Original Medicare offers the same coverage nationwide. However, Medicare Advantage plans may only provide specific coverage in certain areas. If you move to a new area or travel outside your current service area, your Medicare Advantage plan might not have providers available.
The Medicare Open Enrollment period runs from October 15, 2024, to December 7, 2024. We encourage you to explore all your options, including returning to Original Medicare. While Kittitas Valley Healthcare is contracted with a few Medicare Advantage plans, we recommend that our Medicare-eligible patients choose Original Medicare with a good supplemental insurance plan.
Selecting the right Medicare plan can be complicated and confusing, but there are excellent insurance brokers in Ellensburg who can help. We suggest using a local medical insurance broker for any questions you may have.
You can also find assistance by navigating to: www.insurance.wa.gov/about-shiba-services.
KVH is committed to providing health care services to all persons in need of medical attention regardless of ability to pay. You can find our full Financial Assistance Policy on our website at www.kvhealthcare.org. If you have any questions, please reach out to our Patient Financial Services Department at 509.933.8657. Thank you for choosing KVH at Your Home for Health.
Michele Wurl
Kittitas Valley Healthcare
Chief Communications Officer