Medicare is complicated. With so many plans and options, it is not surprising that so many Americans over 65 have a suboptimal plan in place. And while for patients, it often means they might miss coverage for what they actually need, or overpay for what they use, patients with the wrong Medicare plan also affect the care providers who care for them.

Nearly 90 percent of older Americans plan to enroll or are already participating in Medicare and 98% of primary care providers accept Medicare insurance plans. Yet most Medicare participants don’t know how to choose the best plan, almost half of Medicare beneficiaries haven’t ever considered changing their plan and many don’t even know they actually could. Result? Patients overpay for services they could have covered under a more suitable plan or overpay for coverage they actually don’t need. If you, as an independent provider, believe this doesn’t affect you, you are wrong.

Many Medicare patients pay co-pays, but they don’t need to

Many services under Medicare require the patient to pay 20% co-pay and Medicare actually requires care providers to collect it. And although the co-pay policy ensures, to a certain degree, that patients only seek necessary care, for many this means a financial burden that is unnecessary: a burden that could be avoided with a better Medicare plan or a supplemental coverage. This, for example, means that some patients might refuse to accept care they might benefit from tremendously, but that might require a copay, such as remote patient monitoring. Patients often don’t realize that remote patient monitoring affords them a better, preventative care that, in the long run, saves them money for hospitalization and expensive procedures by avoiding it all together. 

Medicare patients who overpay might skip visits or medication

Majority of Medicare patients are retired, which means they live on fixed income and when the budget is tight, many might start avoiding doctors’ visits or start skipping medication schedules, all in an attempt to lower their medical bills. As a result, practices see fewer patients and patients might end up in the emergency room instead. This doesn’t have a financial effect on medical practices alone but the patients themselves, as a short term savings often balloon to long term greater debts.

Medicare patients with high co-pays might have to refuse care programs that benefit them

Innovative care programs such as chronic care management or remote patient monitoring were designed to drive better, continuous care. They are built on a preventative care model that supports faster intervention and improved health outcomes while cutting healthcare cost for both the payer and the patient. Yet patients with a suboptimal Medicare plan might opt-out in fear of increased monthly cost with a mandatory co-pay, despite the promise of better healthcare and long term savings from preventing hospitalization and acute care.

Help your patient population explore better, more suitable Medicare plans. It’s a win-win for both you and them and can be rather easy.

Recent national survey showed more than 70% of Medicare beneficiaries wish they had better understanding how Medicare works. With so many plan options available, picking the right Medicare plan is stressful and confusing for seniors and they often look for help during their doctor’s appointment, hoping their care provider will point them in the right direction. The "right" Medicare plan will vary, depending on a patient’s age, disease states, spouse’s insurance, medications, and more but it’s not difficult to understand the basics or connect the patient with the right assistance. 

Lara Health makes it easy for your staff to get a basic understanding of the available Medicare options, and can pair your patients with a CMS trained counselor who can advise them on initial enrollment, making changes to their existing Medicare plan, or possibly adding supplemental coverage like Medigap.

Help your patients get a better suited Medicare coverage, contact Lara Health at help@lara.health to provide you with a free, comprehensive Medicare guide and a CMS trained counselor to help your patients select the best Medicare plan for them.