Conversations and Comparisons: Learn more about Medicare and Medicare Advantage
October brings to mind colorful foliage, a drop in temperature, celebrations like Halloween, and of course, Open Enrollment for Medicare.
If Open Enrollment wasn’t already part of your October calendar items, you might not be near the age of 65, which is when the Social Security Administration suggests you enroll in Medicare Part A (hospital insurance) and Part B (medical insurance). When you add in the Medicare Advantage alternatives (Part C) and prescription coverage (Part D), you might feel lost in a wilderness of options.
Those still covered by an employer group health plan at age 65 or older might not yet need to sign up, but for others, October 15 to December 7 is the window known as Medicare Open Enrollment—the time to sign up for benefits and avoid late enrollment penalties.
Changes to plans accepted at LMH Health
In early September, LMH Health notified patients that the health system will no longer accept Aetna or Humana Medicare Advantage insurance effective January 1, 2025. This makes LMH one of a growing number of health systems dropping Medicare Advantage plans across the country. Closer to home, North Kansas City Hospital and Meritas Health providers will no longer provide care as an in-network provider with Aetna Medicare Advantage plans.
“Prior authorization denials disrupt patient care and Medicare Advantage plans have the most excessive prior authorization denial rate. They often ‘delay, deny or don’t pay,’ allowing private companies to make more money,” said Rob Chestnut, LMH Health Chief Financial Officer.
Chestnut went on to say that while the companies make more money, patient care is adversely impacted adding a level of anxiety that patients shouldn’t have to experience.
The delays, denials and low payments also impact the hospital. Among the Medicare MA plans accepted by LMH, Aetna and Humana have the lowest reimbursement rates, paying the hospital
LMH Health President and CEO Russ Johnson explained, “We simply cannot continue to be part of these plans which do not adequately reimburse our physicians, advanced practice nurses and others for the service they provide,” Johnson said. “Our first priority is to the communities we serve. That means maintaining a healthy financial foundation that supports excellent care for every patient.”
My plan won't be accepted. Now what?
Navigating the variety of Medicare and Medicare Advantage options can be overwhelming. Luckily, LMH Health is here to provide you with guides.
At 4:30 p.m. on Thursday, October 3, LMH Health will offer Conversations and Comparisons, a seminar on Medicare and Medicare Advantage coverage. The event will take place in the Auditorium at the LMH Main Campus, 330 Arkansas Street, Lawrence. A panel of experts including representatives from the Douglas County Senior Resource Center, the Kansas Hospital Association, a member of the LMH Patient Accounts team, and two members of the LMH Board of Trustees—Pat Brown, who has extensive experience in retirement planning and Medicare options; and Dr. Shari Quick, a physician at LMH who experiences the impact of poor coverage on patients first hand. The panel will explain the distinctions between the types of plans and answer audience questions. If you can’t attend in person, the seminar will be available on the LMH website after the event.
Megan Poindexter, executive director at the Senior Resource Center, said that if you need help navigating Medicare plans, you can call after October 1 to make an appointment with the Center’s Medicare counselors.
“Our team is trained by the state’s Senior Health Insurance Counseling for Kansas (SHICK) program to help you find the solution that works best for you, not to sell you anything,” she said. “Our counselors will be available throughout open enrollment from October 15 through December 7.”
Poindexter encourages beneficiaries to make their appointment online at www.YourSRC.org starting October 1 for the best access to open appointments. She said additional appointment times will be added over the course of Open Enrollment and any voice messages left on SRC’s Medicare phone line will be returned in the order they’re received.
Johnson said it was important for LMH Health to make the change ahead of the open enrollment period so that patients would face the least amount of disruption. He is appreciative for the collaboration of community partners to help those affected navigate their options.
“We want our patients to spend their energy focusing on a healthy life, not worrying about what their insurance will cover at those times they require medical intervention,” Johnson said. “This community gathering is a chance to learn about the differences of the plans and what might work best for your personal situation. Bringing this great panel of experts together is another way we can truly be a trusted partner.”
For more information, visit www.lmh.org/medicare.
