Original Medicare & Medicare Advantage: Are Your Patients Educated On The Differences?

Written by: Rina Foster

During a recent visit with my dad our conversation turned to my work. I started talking with him about Medicare and the upcoming Open Enrollment Period, the time of year (October 15-December 7) when adults age 65+ can enroll or make changes to their health coverage.

I told him about how I was working with an independent physician group on a campaign to educate their original Medicare patients on the benefits of Medicare Advantage with their particular physician group. The ultimate goal of course being to switch a defined number of original Medicare patients to Medicare Advantage plans. The reason? Because for some of their patients, a Medicare Advantage plan might be the way to go – saving them money – and offering them benefits not available through original Medicare, like vision and dental coverage, gym memberships and even hearing aids. For an independent physician group, keeping their patient population healthy is more important than ever for long-term profitability. And for some groups, Medicare Advantage plans enable them to better manage care for their patients.

Unlike other work stories I’ve told him this story piqued his interest. He turned 64 this past November and like many people “aging into” Medicare knows very little about his options and how to even shop for and choose a Medicare plan.

This is where independent physician groups have an opportunity! When older adults are eligible for Medicare they have a fundamental choice to make – enroll in original Medicare or opt into a Medicare Advantage plan. They often default to original Medicare, even though it may not be the best plan for them, simply because it’s what the government provides to those who turn 65.

As their primary care doctor, you should be educating your patients about Medicare Open Enrollment and the importance of evaluating plans, but you also have an opportunity to switch patients enrolled in original Medicare to Medicare Advantage plans.

Are you doing everything you can to educate your patients about the differences between original Medicare and Medicare Advantage?

Here are a few things to think about:

Your Patients

When it comes to switching and even choosing a plan, lots of older adults shop for coverage, but very few switch, in fact, according to Deft Research’s 2016 Medicare Shopping and Switching Study, only 6% of original Medicare patients switched to Medicare Advantage. Of the patients who did switch plans, more than half of them shopped persistently throughout OEP. This means you need to be engaging with your patients persistently throughout OEP because they are paying attention. Provide them with information about the differences between original Medicare and Medicare Advantage. Ensure your messaging hits on key differentiators that are important to older adults like cost, coverage and customer service.

Health Insurance Brokers and Agents

What is your relationship like with your payor partners? At the end of the day, the agents ultimately enroll patients in a plan, but ensuring that they understand the pros and cons of Medicare Advantage at your independent physician group vs original Medicare will help them guide seniors to the plan that is best for them. So, make sure you’re engaging and equipping agents with the right materials and providing training to them.

Your Internal Team

Do your doctors, care teams, nurses know the benefits of a Medicare Advantage plan with your physician group versus original Medicare? Are they prepared for the questions your patients may have? And do they know how to start a conversation about Open Enrollment with patients? If your answer is no, it’s time for training.

Create training tools and resources to help educate your internal teams. These can be anything from in-practice experience maps showing how patients go through your practice to equipping your team with scripts and Q&A sheets. Role play with your teams to ensure they are comfortable speaking with patients and know where to direct patients who want to review their plans.