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Traditional Medicare vs. Medicare Advantage Plans
Medicare offers comprehensive health insurance coverage to individuals beginning at age 65 and to others who meet special eligibility criteria. As a Medicare beneficiary, you have a tremendous amount of options regarding the future of your health insurance coverage. When you first become eligible for Medicare, you will have seven months to sign-up for Part A and/or Part B coverage. There is an annual open-enrollment period where a person may choose a Medicare Advantage plan instead of traditional Medicare. This enrollment period is typically October 15th – December 7th. If you do switch to a Medicare Advantage plan and you realize you made a mistake, you will usually have an opportunity to go back to traditional Medicare between January 1st and February 14th. It is important to review the terms and conditions of each policy to ensure you select the plan that best meets your potential health care needs.
Your biggest decision is whether you will choose to stay with traditional Medicare or convert to a private Medicare Advantage HMO or PPO plan. Medicare Advantage plans are also referred to as “replacement” plans because they replace traditional Medicare and supplemental plans. Again, it is prudent to review your options because certain plans may not be accepted by all providers and they may have benefit limitations or exclusions that will increase your out-of-pocket expenses.
To assist you in this choice, Sarasota Memorial Health Care System currently accepts traditional Medicare and supplemental plans. We are also in-network with most Medicare Advantage plans offered by Aetna, Blue Cross and Blue Shield, Humana, and United Healthcare. To ensure that we are a participating provider with your Medicare Advantage plan, please contact the Member Services number located on the back of your insurance card and verify if Sarasota Memorial Hospital is an in-network provider.
We do not accept all Medicare Advantage plans because, in general, they have more stringent guidelines than original Medicare and are more likely to deny services and claims, while adding burdensome administrative responsibilities.
Medicare Supplements – Standard vs. Select
Sarasota Memorial Health Care System facilities accept all standard Medicare supplemental plans. If you choose a “Medicare Select” supplemental plan, you will likely be responsible for the Part A deductible for any non-emergent inpatient hospital stay. Additionally, your plan may also make you responsible for your 20% outpatient co-insurance amount, while standard supplements do not.
To learn more about Medicare, visit medicare.gov on the web for a free copy of the “Medicare & You” handbook, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.