Opuscula Medicare questions I should have asked

I’VE HAD A MEDICARE ADVANTAGE plan for a number of years. Over those years I have had at least 4 different insurers; one, AvMed, twice.

I thought I knew all the questions to ask.

I didn’t (know all the questions to ask).

My current plan had a few surprises. Had I done my homework as I should have done my homework, there would have been no surprises, so I only have myself to blame.

Surprise #1: Closest Urgent Care facility.

The closest Urgent Care facility is more than 5 miles away.

That’s not much, but they are congested miles.

Another, slightly farther facility, is hidden away. I tried to reconnoiter the place the other day and failed to find it.

While I rarely go to Urgent Care facilities – over the last 5 years I’ve gone twice – when I need urgent care, I want a nearby, easy-to-get-to facility.

My current plan fails in that respect.

Surprise #2: Specialists

Over the years I have had two vascular surgeries.

Given my history, I want to know which vascular surgeons are plan providers.

My current plan has one – and he was not even listed by the plan’s online providers’ list. Customer Service gave me his name and contact information.

The surgeonseems to have high marks from his patients; that’s encouraging. The one hospital with which both he and the plan are affiliated has a two-out-of-three star CMS (Medicare) rating.

My real concern is “Who is this practitioner’s anesthesiologist?” The “gas passer” (showing my age) is at least as important – if not more so – to the patient’s well being than the cutter.

Neither the urgent care issue nor the vascular surgeon are “show stoppers,” but they pretty much assure than for 2019 I will go back – for the third time – to my first Medicare Advantage insurer, even if I have a copay for a prescription other insurers place in a “no co-pay” category.

I still will keep the Primary Care Physician I’ve had for several years and I’ll once again have access to the vascular surgeon AND anesthesiologist – whom I hopefully will NOT need – as well as convenient Urgent Care facilities. I realize that everything is “subject to change,” but if they don’t . . .

Bottom line

It turns out that there are more things to check than co-pays.

The plan’s Evidence of Coverage (EOC) remains the place to start when comparing plans, but the plans’ formularies and providers’ lists also should be checked. All of the foregoing should be available online not later than 1 December; hopefully it will be online when Medicare Advantage plan enrollment commences in October (if not, contact the insurer and ask specific questions; it’s a competitive business and the insurers want your custom).

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Comments on Medicare Checklist – Part 2