In a previous blog, I shared some information and tips about how Medicare covers (or doesn’t cover) preventive care. It was a good generalization related to Original Medicare as a whole. To take it a step further, let’s dive into preventive care and how it pertains to Advantage Plans or Part C. As a rule, if Original Medicare covers a medical service, then the Advantage Plan is required to cover it as well. There are, however, differences in cost share, authorization processes and how the covered service is billed and paid. In addition, one could argue that Advantage Plans go beyond Original Medicare in covering preventive services. Let’s look at how that plays out.
No Limit to Primary Care
Where Original Medicare doesn’t cover annual physicals with your family doctor, Advantage Plans do. You can literally see your Primary Care Provider (PCP) as much as you want and for any reason. The visit will be covered, and, in most cases, you will have $0 copay for that visit. You may have a small copay if your PCP is out of network, but the visit is still covered. In addition, most plans will reach out to new members and annually thereafter to offer an in-home physical evaluation and medication review from a Nurse Practitioner or Mobile Doctor. I mean it can be annoying how much they want to keep you healthy. I have to remind my clients, at times, that they can decline these in home visits. I am of the opinion that as long as you have transportation to your doctor and see one regularly, you don’t necessarily need the in-home visit. However, isn’t it great that the service is offered?
HRA: Health Risk Assessment
There is a process called an HRA or Health Risk Assessment that is performed during enrollment into an Advantage Plan. As an agent, I perform this with my clients at the time of enrollment. It is an optional health questionnaire whose main purpose is to alert the Advantage Plan of any special or additional needs the member might have in order to keep them healthy. In some cases, it will prompt a Case Manager to reach out to the member to ensure they have access to care, medications, and transportation to doctors’ appointments. Many of the questionnaires address food insecurity, issues with paying utilities, transportation to appointments in addition to major chronic illnesses that might require extra monitoring. This questionnaire is completely optional and when completed, has no bearing on the benefits, pricing or qualifying for the plan. It is simply a tool to keep members as healthy as possible.
Dental, Vision and Hearing
Medicare does not cover any of this. Marketplace plans don’t either. In both cases, you would have to pay extra premiums for this coverage on a private basis. All Advantage Plans, however, include at least a basic level of Dental, Vision and Hearing. I would put this in the category of preventive care. Ask any Dentist about how good oral health and hygiene can help in the prevention of cardiovascular disease. Additionally, when aging people have healthier teeth and gums, their nutrition is better. They have less pain and issues with chewing and eating. I have often enrolled clients in Advantage Plans who state they haven’t been to a Dentist in many years but will now since they have access to Dental coverage at $0 monthly premium. I am all too happy to print them a list of in network Dentists within a 5–10-mile radius of their home. With the Vision coverage, you get routine vision exams and some help with glasses. Similarly, the Hearing coverage includes annual hearing exams and some help with hearing aids. This is all more incentive to take care of these things that may seem otherwise ‘non-essential’ given a fixed income.
Over The Counter and Fitness Benefits
Most, if not all, Advantage Plans now offer money for over the counter items. It is typically an amount per quarter that the member can spend on vitamins, cold medicine, wound supplies, pain relievers, allergy medicine, toothpaste and more. Some plans have credit cards you can use at retail locations and other plans have an online catalogue where you can shop and have the items shipped free to your door. When you combine this with free gym memberships, wellness programs and some fitness reimbursement benefits, you can see a trend in Advantage Plans’ desire to keep you healthy. And why do you think they put so many resources into these preventive measures? In the long run, they save money and thereby make more money. Let’s be real, these are insurance companies, and they are in business to make money. But I don’t mind if keeping members healthy is the chosen strategy to do it!
No Plan is Perfect
Let me be clear in that I am not trying to paint a picture that Advantage Plans are perfect or the best way to go for everyone. There are cons and disadvantages to these plans as well. As I always tell clients, no one plan is best for everyone. The choice between Original Medicare with a Medigap plan versus an Advantage Plan is a very personal decision based on many individual factors. That is where meeting with a local independent agent can help and leads to better outcomes and higher satisfaction!
CDI is here to help you manage your healthcare costs and find the best options for your unique situation. We can meet in person or virtually. Reach out if you would like more information. Email carrie@cdi-cares.com or check out www.cdi-cares.com for a contact page and other helpful blogs.
QUOTE OF THE DAY:
“Let’s build wellness rather than treating disease.”
- Dr. Bruce Daggy
