What happens if your doctor was fired by your Medicare Advantage plan? It happens. With reduced Medicare funding under Obamacare it will be more difficult to keep your doctor no matter how much you like them.
Just ask Mary Ann Catalano
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My doctor was fired
Mary Ann Catalano has been using the doctors at Dermatological Care for over 40 years. But all this is about to change. Her doctor was fired.
In 1990, doctors found two types of cancer on her face and scalp. Years later they flagged a type of cancer that they warned could also be on her colon. That led her to a colonoscopy and subsequent removal of pre-cancerous spot on her colon. Recently, they discovered her husband’s skin cancer.
Now, at 68 and in the middle of her contract term, UnitedHealthcare is kicking the entire Dermatological Care staff out of her Medicare Advantage network.
This would not have happened if Mary Ann had original Medicare and a Medigap plan.
Funding cuts required by Obamacare mean all Medicare Advantage plans will have to get skinny if they are to survive.
United Health Care sent out pink slips to almost 1,000 docs in Missouri the first part of June. Medicare Advantage patients can still see their doctor if they want but out of network penalties may apply.
With 17 eligibilities for special enrollment, (insurance agent Bill) Steinlage said there’s an “excellent chance” many consumers will qualify for one. The best thing to do, he said, is visit an independent broker who can help you navigate the system.
Yes, but if your doctor was fired from the plan that is not one of those 17 SEP opportunities.
Mary Ann makes a tough choice after her doctor was fired
Moving to another doctor was not an option in Mary Ann’s mind.
For Catalano, in St. Louis County, she plans to stay with Dr. Larry Wang at Dermatological Care and pay out of pocket.
She recognizes this could turn into a financial burden after office visit fees, biopsies and more, but “that doctor knows everything about us,” she said. “I’ll just tell them I gotta make payments.”
Financial burden’s are not something seniors should stress about during their retirement years. Unfortunately, most seniors choose Medicare Advantage plans based on the low going in premium. They never think about how costly these plans can be once your health changes.
Nor do they consider the cost of health care when their doctor is fired.
United Health Care is not alone
Someone had to be the first. United Health Care has more seniors on Medicare Advantage plans than any other carrier in the country. United is firing doctors to save money, how long before their competitors do the same?
CMS released guidelines in April that will allow Medicare patients to change coverage one time during the year for whatever reason. Those guidelines won’t be implemented until 2015, though, and there’s one other catch. The guidelines state it would have to be a five-star plan, which are the highest rated Advantage plans.
In Georgia there is only one 5 star plan and it isn’t United Health Care.
You MAY qualify for an SEP under Medicare guidelines, if your doctor is fired you change docs or wait until the next open enrollment. New doctors are especially challenging if you live in a rural area and have a medical condition that few doctors are able to treat.
Dave and Alice
I have clients that live in rural Georgia. At one time they had a Blue Cross Medicare Advantage plan, and then it went away. That did create a Special Enrollment Period for them. Both were in reasonably good health but living in a small town meant limited doctor choices. Their family doctor was not in any of the new plans and the only way for them to have the ability to use a doctor of THEIR CHOICE was to return to original Medicare and pick up a supplement plan.
Georgia Medicare Plans has access to over 170 different Medigap plans and can usually find a plan that meets YOUR needs and budget. We helped Dave and Alice find an affordable plan that allowed them to keep their doctors.
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