Medicare Advantage clients worry about provider networks

By Susan Rupe

Editor's note: The following article is part of a series on what Medicare clients are asking their advisors prior to open enrollment period.

Medicare Advantage plans are the top concern that Katie Diemer said her clients have going into the annual Medicare open enrollment season.

Diemer is an insurance specialist based in Reinbeck, Iowa.

She told InsuranceNewsNet her clients who are on Medicare have the same main concerns each year – their provider networks and their prescription drugs.

“They want to make sure that their doctors and hospitals will be in network with their advantage plan, and my clients who are Medicare Supplement plans want to make sure their prescriptions will be affordable for the coming year.”

She said at least one carrier in her area still has a network that includes most of the major health care providers in the region, “so I have some peace of mind that we have one carrier we can recommend where our clients still can be in network.”

Diemer said that in Iowa, some Medicare plans have released sneak peeks of what the coming year will bring for their offerings.

“It seems like there will be some major changes coming for advantage plans, mainly about networks that will change, and I also believe there probably will be some higher copays this year. I also believe we might see plans that are currently zero premium moving to a low premium.”

But even if Medicare Advantage plans move away from zero premiums, Diemer said she still believes advantage plans offer her clients some economical options.

“There will still be some good advantage plans for clients versus a Medicare Supplement because some of the supplements are really expensive and their drug plan is really expensive,” she said. “So even with a lower-premium advantage plans, clients will still have costs but overall, advantage plans continue to be more cost-effective for them.”

Diemer said she meets with her Medicare clients each year to review their plans: whether their doctors and hospitals remain in network, what prescription drugs they take and whether they are covered.

“We’re going to figure out what’s best for them – not what’s best for me or for the company,” she said. “I got into insurance because I want to help people and that’s my way of doing things.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].