Medicare Advantage Plans are a popular choice among seniors, but they can be difficult to navigate when you have a chronic illness and doing it alone. These plans offer extra benefits like routine vision and dental care. However, it is important to understand the limitations and restrictions of these plans for patients who suffer from a chronic condition. LifeSpan Care Management understands the challenges of navigating Medicare Advantage Plans for chronically ill patients and offers guidance and resources. Here are some things to be aware of and tips of navigating the system.
Out-of-Pocket Expenses
Medicare Advantage Plans have annual out-of-pocket maximums that limit how much you have to pay in medical expenses each year. However, these out-of-pocket maximums can be higher than what you would pay under traditional Medicare. Additionally, some plans will still charge a co-pay or coinsurance on certain services that are covered by Original Medicare at no cost or with lower copays. It is important to check your plan’s coverage before signing up so that you know what fees you may incur due to your chronic illness. LifeSpan CM helps patients and families determine which healthcare plan fits their situation best. Getting a Plan of Care can help put the finances and plan for the future into perspective.
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Prescription Drug Coverage
Another common challenge with Medicare Advantage Plans is prescription drug coverage (Part D). Some plans require preauthorization for certain drugs which can be time-consuming and confusing.
Additionally, many plans have formularies—lists of covered medications—that may not include all the drugs your doctor prescribes for your chronic condition. And if they do cover your medications, they may require higher copays or coinsurance than traditional Part D plans. With possible options for generic drugs.
Out-of-Network Providers
Another possible challenge is finding providers who accept your plan’s network and also specialize in treating chronic illnesses. If there are no providers available in your plan’s network who can treat your condition, then you may need to see an out-of-network provider and pay more for their services. You should also double check whether specialists like physical therapists or psychologists are included in the plan’s network. Primary care doctors and other medical professionals may refer you to a specialist but this won’t always mean who treats chronic conditions will be covered under your plan.
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Navigating a Medicare Advantage Plan can be challenging if you have a chronic illness due to the potential for high out-of-pocket costs, limited access to prescription drugs, and difficulty finding providers who accept the plan’s network.
Here at LifeSpan CM, we conduct thorough research on different options carefully before suggesting enrolling in a plan so that you understand how it will affect your healthcare needs before making a decision. With careful consideration and research, seniors with chronic illnesses can find a plan that meets their unique needs while providing quality care at an affordable price point.
Not sure which plan to choose for your condition? Call for a consultation