Learn About Medicare Advantage Plans (Medicare Open Enrollment series)

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest, Crystal Strong, from the South Carolina Department on Aging.

Crystal is the Program Director for the State Health Insurance Assistance Program (SHIP), the Medicare Improvements for Patients and Providers Act (MIPPA) program, and the Senior Medicare Patrol (SMP) program within the South Carolina Department on Aging (SCDOA). She provides oversight and direction to the state grantees to support their work assisting Medicare beneficiaries, their families, and caregivers through outreach, counseling, and education. In this role, she is also responsible for the education and certification of the counselors/volunteers statewide. Crystal actively supports the program networks by providing training and technical assistance whenever possible. Prior to this position, Crystal has functioned in various roles and programs since 2000 when her tenure at SCDOA began. Crystal holds a Bachelor of Science in Nursing from South Carolina State University.  

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

Medicare Open Enrollment 2023 - October 15 - December 7

KEY TOPICS
00:29: Overview, introduction of guest, Crystal Strong
02:40: Introduction of Medicare Advantage
03:55: Medigap and Medicare Advantage
04:35: Disadvantages of Medicare Advantage plans
06:15: Types of Medicare Advantage plans
08:35: Open Enrollment
10:10: Final thoughts

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RESOURCES

 BFCC-QIO Information for stakeholders: www.keproqio.com/partners

 BFCC-QIO Information for people who have Medicare: www.keproqio.com/bene

 SHIP information: www.shiphelp.org

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: https://youtu.be/U78mgVaM12M

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their healthcare journey.  Thanks for joining us. Now let’s get started.

Kia Weaver
Hello everyone and welcome to another edition of Kepro's podcast, Aging Health Matters. This is Kia Weaver, Outreach Specialist with Kepro, here to introduce today's topic. Just as a reminder, being the QIO for 29 states, we have three key services for people who have Medicare: appeals, quality of care complaints, and Immediate Advocacy services. More information on these topics is available on our website at www.www.keproqio.com.

We also work with many outstanding partners to help spread information about the Medicare program and its benefits. While we greatly appreciate their partnerships, we also want to be clear that the opinions and guidance expressed by them in this podcast are solely theirs or their agencies and not necessarily those of Kepro, CMS, or the Medicare program. Please also keep in mind that state-by-state guidance may differ as well.

So today, with Open Enrollment coming soon, we'll be talking with our guest, Crystal Strong, from the State Health Assistance Program, also known as SHIP, about the Medicare Advantage option for getting your Medicare benefits. This is also known as Medicare Part C. So our guest today is Crystal Strong.

She is the Program Manager for South Carolina State Health Insurance and Senior Medicare Programs at the South Carolina Department on Aging. Crystal, thank you so much for being here today. Can you please tell us a little bit more about what you do?

Crystal Strong
 Sure. Thank you for having me. As you mentioned, I work at the South Carolina Department on Aging, and I work with two key programs with Medicare, the State Health Insurance Assistance Program, otherwise known as SHIP, and also the Senior Medicare Patrol program or SMP, which focuses on Medicare fraud. I've been with the agency in various capacities for now going on 23 years.

Kia Weaver
Perfect. Thank you so much Crystal. And for those who are unfamiliar, what is Medicare Advantage plan?

Crystal Strong
 Medicare Advantage plans are another way for beneficiaries, Medicare beneficiaries, to get their Medicare Part A and Part B services, so your inpatient and your outpatient services. Part C Medicare Advantage product, which is otherwise known as Medicare Part C, encompasses, as I mentioned, Part A benefit, its Part B benefits, and most of the time D, which is your prescription drug benefit, and it takes it and puts it, I guess you could say, all under one umbrella. In addition to not all only offering Part A and Part B benefits and usually the D, the prescription, it also gives you some added benefits. Since you've seen those commercials that are usually on TV, they can provide dental, vision, and hearing benefits along with some of them offer gym memberships.

They offer an over-the-counter prescription card where they add money to it so that beneficiaries can get over-the-counter drugs, and that particular plan pays for them as well. They also promote other health and wellness benefits within them. So it is just a different way for Medicare beneficiaries to get their Medicare benefits.

Kia Weaver
Great. And just a quick follow-up question, would you need Medigap with a Medicare Advantage plan?

Crystal Strong
 No. All Medigap or Medicare supplements, same thing, do not work with Medicare Part C or a Medicare Advantage plan. If you already have a Medigap policy or Medicare supplemental insurance, you actually cannot have a Medicare Advantage product too. So you can't be sold or get enrolled into Medicare Part C If you already have a Medicare supplement.

Kia Weaver
OK, great. Thanks for adding that. And you named a lot of good benefits to Medicare Advantage plans. What are some of the disadvantages to joining a Medicare Advantage plan?

Crystal Strong
 One I would say that with advantage plans, with traditional Medicare, that red, white, and blue card Parts A and Part B, you can go anywhere in the 50 states and our territories and be covered. Unfortunately, with a Medicare Advantage plan that does not happen. You have to have a lot of times referrals to see your doctors and/or specialist.

If you travel sometimes it does not travel state-to-state with you. So where you could go with traditional Medicare, an advantage plan may not move the same way. Sometimes the providers can join or leave the plan’s network at any time during the year, and therefore, you may unfortunately have to find a new provider if that provider leaves the plan.

In addition to that, the plan itself may leave your area, and therefore, you're going to have to find another plan to join too. And then also with that I want to add if you choose a provider that's not within that network, then you're going to have to pay out-of-network cost as well as sometimes the provider that you're currently with may not be a part of advantage plans or don't accept  advantage plans.

Therefore, that is a disadvantage to you if you're trying to join one. Your doctors may not be covered in or be in the network.

Kia Weaver
Thank you so much. And are there different types of Medicare Advantage plans, and if so, how would a beneficiary know which plan to choose?

Crystal Strong 
There are many different ones. One they are based on the areas of service is based on your zip code. So in order to choose the correct advantage plan, we use a tool on medicare.gov, and that is called the Medicare Plan Finder. 

And so a beneficiary would put it in as well. They can do it themselves or as I mentioned, with the program that I have, we have counselors all over the state that can assist a beneficiary in narrowing down their choice process. So they would put their zip code in and then their medications because your medications also determine which plan is going to be better suited for you.

So whereas one friend is in one plan, and you might want to join that plan, that Medicare Advantage plan may not be offered in your zip code. There are lot of things that you have to look at.

So once they find a plan that covers their meds, that's in their zip code, you also have to make sure that your doctors and specialists that you use accept that plan as well because it may be good for your drugs; however, your doctors may not be in in that network or may not even accept advantage plans. So that's not going to be a good option for you, or you may have to choose a different plan.

Kia Weaver
OK. So just to make sure I understand correctly, beneficiaries can either go on the medicare.gov website and do the Medicare Advantage Plan Finder, or they can call a phone number, is that correct?

Crystal Strong 
Absolutely. They can call our toll-free number, which will take them to our office. It's 1-800-868-9095. They can call 1-800 Medicare as well as our toll-free number. And then once they call our toll-free number, they will route them to one of the counselors that represent their region. So whatever county they're calling from, there is a counselor that represents that particular region or county.

Kia Weaver
OK, perfect. Thank you so much.

Crystal Strong
 You're welcome.

Kia Weaver
So that was all great information. Do you have anything else that you'd like to share with people who might be looking for Medicare Advantage plans or providers that work with beneficiaries that might be looking to get on Medicare Advantage plans?

Crystal Strong
 Absolutely. Open Enrollment starts for advantage plans and/or prescription drug plans on October 15, and it runs through December 7, and that's the opportunity that beneficiaries have to either join an advantage plan if they don't currently have one or make changes to the current plan that they have.

In addition to Open Enrollment for everyone, persons that are in Medicare Advantage plans that may not make that decision during that time also have an additional time frame to make changes, and that is January 1 through March 31 of the following year, so if a beneficiary gets into an advantage plan during the regular Open Enrollment, and for some reason does not like it or wants to change to another one then or completely come out of it, they also have that opportunity to do that in January, but if you want to get in one and see how it works or change the one, Open Enrollment October 15 through December 7, and I'll just want to give our number again. It's 1-800-868-9095.

Kia Weaver
Perfect. Thanks for adding that Crystal and thank you so much for your time here today and giving our listeners such valuable information.

And for those who would like more information about our services as well as our upcoming podcast episodes, please feel free to sign up for our newsletter as well as subscribe to our new YouTube channel. Our Helpline phone number as well as a link to sign up for our newsletter will be available in the show notes. And we also have several resources on our website, which again is www.keproqio.com.

Kia Weaver
Thanks again, Crystal, and thank you to our listeners for tuning in. Please stay tuned for our next episode.

Crystal Strong
Thank you.