(From BVHS President and CEO Myron Lewis)

Medicare open enrollment season is upon us and I encourage eligible community members (generally age 65 or older) to review their Medicare health coverage plans by the December 7 deadline. The choice comes down to traditional Medicare or Medicare Advantage, and the difference might surprise you. Medicare Advantage may seem attractive because of its name, positive portrayal in high-value advertisements, and promise to cover all aspects of care, including dental, vision, and prescriptions. “Benefit” does not mean the plan will be better for you or your health care provider, as these plans carry significant risks.

When you choose an Advantage plan, you’re ditching traditional Medicare coverage for an option that increasingly denies a large percentage of claims. In recent years, many patients have told us about the difficulty in receiving follow-up care prescribed by their doctor. As an example, we have seen that Medicare Advantage plans delay or deny admission and care to facilities such as nursing homes and rehabilitation centers. As we examine what is happening, our doctors are finding that the prior authorization process used by Advantage plans often delays the care of our patients. You can learn more about the risks of Medicare Advantage plans from our neighbors at the Kentucky Hospital Association by visiting kyha.com/medicare-advantage.

Medicare Advantage is increasingly dominated by large, for-profit insurance companies that are accountable to their shareholders – not patients or hospitals. As a result, they continually find loopholes in federal regulations to capitalize on your tax dollars. Additionally, delays and refusal processes increase administrative costs for local providers.

We have had situations where patients had to travel long distances from their home community to find a provider covered by their Medicare Advantage plan. They may also find that their Advantage plans have changed the formulary of the drugs they cover, causing confusion for patients and the doctors who care for them.

HAS Blanchard Valley Health Systemwe work to help the community manage their insurance claims, as Medicare Advantage companies identify creative ways to avoid providing or paying for prescribed services. Our nation’s healthcare system is already too complex, and Medicare Advantage plans make it even more complex for patients and healthcare providers.

There is another solution, and it is not the “benefit” advertised. Choosing traditional Medicare over Medicare Advantage can lead to better patient outcomes and

healthcare providers. Consumer Reports’ analysis of Medicare options indicates that more people in rural areas like ours are returning to traditional Medicare because of the problems highlighted.

Although many factors can influence your plan choice, I urge you to consider the impact on your access to health care and on local community health care organizations when making your decision. We know that having to evaluate your coverage every year is difficult and takes a lot of time for you and your family. Resources for comparing plans are available from the Ohio Department of Insurance at Insurance.ohio.gov/medicare.

The open enrollment period is also a great time to select a primary care provider or schedule an appointment with a specialist. You can call 419.422.APPT to be one of the more than 4,000 patients we treat every day. We work hard to get you the care you need and to ensure your care is covered by your Medicare plan.

Myron D. Lewis, FACHE

President and CEO

Blanchard Valley Health System