(From BVHS President and CEO Myron Lewis)

Medicare Open Enrollment season is upon us, and I encourage eligible members of the community (generally age 65 or older) to review their Medicare plans by the December 7 deadline. The choice comes down to traditional Medicare or Medicare Advantage, and the difference may surprise you. Medicare Advantage might sound appealing because of its name, positive image on high-dollar ads, and promise to cover all aspects of care, including dental, vision, and prescriptions. “Advantage” does not mean that the plan will be better for you or your healthcare provider because these plans carry significant risk.

When you choose an Advantage plan, you’re giving up traditional Medicare coverage for an option that’s increasingly turning away a large percentage of claims. Over the past several years, I have had many patients share that they struggle to get the follow-up care prescribed by their doctors. As one example, we have seen Medicare Advantage plans delay or deny admission and care in facilities such as nursing homes and rehabilitation centers. Looking at what’s going on, our doctors are noticing that the prior authorization process used by Advantage plans often delays care for our patients. You can read 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 to patients or hospitals. As a result, they continually find loopholes in federal regulations to cash in on your tax dollars. In addition, the delay and denial process increases administrative costs for local providers.

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

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

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

medical service providers. Consumer Reports’ analysis of Medicare options says more people in rural areas like ours are turning to traditional Medicare because of the problems highlighted.

While many factors may influence your plan choice, I urge you to consider the impact on your access to health care and on your local community health care organizations when making your decision. We know having to evaluate your coverage every year is difficult and time-consuming for you and your family. Plan comparison resources are available through the Ohio Department of Insurance at insurance.ohio.gov/medicare.

Open enrollment is also a great time to select a primary care provider or make a specialty appointment. You can call 419.422.APPT to become one of the more than 4,000 patients we care for every day. We work hard to get you the care you need and to make sure your care is covered by your Medicare plan.

Myron D. Lewis, FACHE

President and Chief Executive Officer

Blanchard Valley Health System