Medicare Your Coverage Options

Which health plan should you choose if you’re ill?

Written by Diane Archer

Which health plan should you choose if you’re ill? Given all the talk about competition in the health care marketplace, you’d think that Medicare and other health plans plans would be out there telling you that they offer the best doctors and hospitals at the best cost for people with specific conditions, e.g. cancer, stroke, or multiple chronic conditions. But, they do not.

Commercial health plans, including Medicare Advantage plans for people with Medicare, make money on healthy people. They don’t want you to know about the quality of the costly care they offer, so they tell you very little about health outcomes for their patients with costly and complex conditions. If you Google, “best Medicare health plan for cancer patients,” see what comes up.

And, to help keep the number cancer patients who enroll in their plans down, commercial health plans–for people with Medicare and working people–generally do not include the best cancer doctors or the best cancer hospitals, such as Memorial Sloan Kettering Cancer Center or M.D. Anderson, in their networks. Kaiser Health News reports that the Affordable Care Act health plans are not including specialty cancer centers in their networks and not covering out-of-network care.

Of course, the data suggest that where you get your care can matter a lot, especially when you’re sick. One recent report showed that people who went to high quality hospitals after a heart attack lived nine to fourteen months longer than people who did not.

What can you do to protect yourself?  As we explain inThree reasons why you can’t pick a health plan that’s right for you,” If you are eligible for Medicare and can afford the upfront costs, consider enrolling in traditional Medicare with supplemental coverage. You may pay more for your coverage up front. But, if you end up needing costly care, it will likely save you money. And, traditional Medicare offers the greatest opportunity for coverage from the doctors and hospitals you want to use. If you go the commercial health plan route, here are two tips for choosing a health plan.

Here’s more from Just Care: 

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1 Comment

  • Unfortunately, my former union, SEIU, sold out its retirees several years ago by agreeing to allow the Commonwealth of PA to dump us, without our consent, into Medicare Advantage plans. There is very little choice in plans and very few exceptions to enrollment in their cheap Medicare Advantage plans. I understand that they did this by obtaining a waiver from Medicare. Private, for-profit commercial Medicare Advantage plans are supposed to be voluntary, but they clearly are not. Now, I do not think that I could purchase a Medigap (supplemental) Policy if I decided that it is in my best interest to give up the union benefit I worked 15 years to earn and enroll in Traditional Medicare. Beware!

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