Dear Editor,
As the retired Administrator of Benton County Health Department, I need to urge Benton County Seniors to carefully consider your health care coverage during open enrollment 11/1/2024-12/15/2024 (for coverage beginning 1/1/2025) and 1/15/2025 (for coverage beginning 2/1/2025).
Home health is a wide range of health care services for an illness or injury in your home. Home health is usually less expensive, more convenient, and as effective as care in hospitals or skilled nursing facilities. These services include nursing care, physical therapy, occupational therapy, speech therapy, medical social services, and help with personal care.
Medicare Advantage plans have several disadvantages:
1. Limited provider network - they typically have smaller networks of doctors, hospitals, nursing homes, and home health agencies than Medicare. This means you may have fewer options for health care providers.
2. Prior authorization - they may require prior authorization for certain services, such as surgery, hospital stays, nursing home, and home health care, to keep costs down. This means you may need to provide additional proof that a service is necessary before the plan will pay. Sometimes, it takes weeks to get the authorization, putting your healthcare on hold.
3. Denial of benefits - they may deny benefits for care they deem not medically necessary. Federal investigators have found that Medicare Advantage plans often deny or delay needed care.
4. Financial instability - Private plans may not be financially stable and could suddenly stop providing coverage.
5. Payments to Providers - Most of the time, payments to the provider are well below what Medicare pays for the service, making it difficult for agencies to accept these payers.
For these reasons, I plead that you review your coverage and re-enroll in straight Medicare to ensure you can receive home health and nursing home care in Benton County.
Respectfully,
Linda Viebrock
