Doctor’s Diary: Medicare open enrollment

Medicare open enrollment

Every year we are inundated with advertisements touting “Medicare open enrollment” where eligible seniors opt into a healthcare plan. Factors involved in this decision are affordability, out-of-pocket costs, benefits, picking a doctor or hospital, and quality of care.

There are two main financial selections:

1) Original Medicare
2) Advantage Medicare

Original Medicare is a single-payer program. It pays 80% of a medical bill, with the remaining 20% payed by the patient unless you purchase “secondary” coverage. There are premiums to pay, and sometimes deductibles. You can choose your doctor, hospital, prescription plan, with coverage throughout the US.

Advantage Medicare is HMO. Contracted groups attempt to keep healthcare costs low, so you might not be able to choose your doctor, hospital, medication plan, while coverage may only be local. There usually are no premiums or deductibles, but extra services are sometimes out-of-pocket. Quality of care could suffer while denial and restrictions are renown. Some groups elevate profit over care and are quick to put patients on hospice.

Needless to say, both selections have pluses and minuses.

You should though disregard advertising enticements and read the fine print to determine which plan best suits your personal needs.

Gene Uzawa Dorio, M.D.

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