Before You Sign Up: Key Questions About Medicare Advantage

Choosing a Medicare Advantage plan is not just about comparing premiums—it requires a closer look at networks, coverage, and long-term consequences. Experts recommend that seniors ask tough questions before enrolling.

For Pawnee County seniors, the following checklist is vital. With only a limited number of local physicians and one hospital serving the community, choosing a plan with narrow provider networks could leave residents with few options. Travel distances, prior approval requirements, and surprise costs can all be especially burdensome in a rural setting. Consulting with local providers before enrolling ensures that residents get the coverage that truly meets their needs—without unexpected hurdles when care is needed most.

First, beneficiaries should assess their current coverage and health needs. Do they travel often? Do they require specific medications or specialists? Would lower premiums offset potentially higher out-of-pocket costs if major procedures—like knee replacements or dialysis—are needed?

Understanding the network is crucial. Medicare Advantage plans often limit access to certain hospitals and physicians. Seniors should call their providers directly to confirm participation. Additionally, many Advantage plans require insurer approval for specialist visits, hospital admissions, or treatments, which can delay or restrict care.

Financially, Medicare Advantage may appear cheaper, but surprise costs can arise. Original Medicare combined with a Medigap plan often offers greater stability. Importantly, while Medigap policies must be offered without medical screening at age 65, individuals applying later can be denied coverage or charged more due to pre-existing conditions.

Again, please note: Consulting with local providers before enrollment ensures that residents receive coverage that truly meets their needs—without unexpected hurdles when care is needed most. 

If you need assistance, please call Senior Health Insurance Counseling for Kansas (SHICK) at 620-225-8230 or attend the free community event on October 6 at 630 PM at the Larned Community Center, which will explain the differences between Original Medicare and Medicare Advantage.