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Hospital sees change in Medicare patient enrollment

Important information regarding Medicare Advantage Plans and Medicare Drug Benefit

Parmer Medical Center and Friona Rural Health Clinic are experiencing an increase in patients that are coming to the hospital and clinic who are no longer enrolled in traditional Medicare. They are now enrolled in one of the Medicare Advantage Plans. Some may have chosen an Advantage plan not realizing it was not accepted by the local healthcare system. Others may have opted out of the Advantage Plan, but the information has not crossed over and they are still listed in the Advantage Plan system and not traditional Medicare. Others may not be aware that their plan has been changed and are surprised to discover they are now enrolled in an Advantage Plan.

The hospital wants to remind the community that we are unable to accept Medicare Advantage Plans (such as Aetna or Humana) due to cost reimbursement (the way the hospital is paid).

The hospital encourages any and all Medicare or Medicare eligible recipients to go online to MyMedicare.gov to check their status or to call the hospital. It is important to check your status now in order to avoid unexpected and/or additional out-of-pocket expenses when using the hospital or clinic services. Please call 806 250-2754 and request a Medicare Plan Check. Our staff will be happy to assist you.

As a review, new types of Medicare Plans were approved in 2005 under Medicare Part C. These are also called Medicare Advantage plans, and are a form of managed care for Medicare beneficiaries. These plans offer benefits which differ from the original Medicare and also have different deductibles and co-pay requirements, depending on the plan. A Medicare Advantage Plan is different from regular Medicare. It is often an HMO or PPO, where your choice of doctors, hospitals, and home health agencies is limited. Medicare Advantage also includes Private Fee for Service (“PFFS”) plans. If you sign up for any Medicare Advantage Plan, you are no longer in the original Medicare payment system.

In addition, your physicians and your hospital have to be separately signed up as “providers” under the Medicare Advantage plans for you to be able to use them as an “in-network” provider and get the deductibles and co-pays that the Medicare Advantage plan promises. However, many physicians and hospitals are not signed up as providers, and you may not be able to use them without paying more out-of-pocket than the plan promises. You cannot use the regular original Medicare while you are signed up under a Medicare Advantage plan.

The new Medicare drug benefit (separate from Medicare Advantage plans) took effect on January 1, 2006. You may also have been enrolled in a drug benefit plan that may affect the Medicare hospital services you receive. There are many choices in Medicare drug plans. You can sign up for a separate drug plan and keep the original Medicare. However, many Medicare Advantage plans offer a drug benefit plan as well, and if you sign up for the drug benefit, you may have also signed up for the Medicare Advantage plan without realizing it. Be sure to read your plan benefits carefully to know exactly what program you are enrolling in.

Certain people that have both Medicare and Medicaid may be automatically enrolled in an Medicare Advantage HMO or PPO. If so, you have the right to choose whether you want to go back to regular Medicare or stay with an HMO or PPO. If you chose to sign up with a Medicare HMO or PPO, you have the right to change back to traditional Medicare. You should check to see if you have been enrolled in one of these plans.

In summary, enrollment in a Medicare Advantage Plan, or for Medicare drug coverage through a Medicare Advantage plan, can affect your hospital services. It can lead to your being charged more for the cost of Medicare services that the plan does not cover. Parmer Medical Center and Friona Rural Health Clinic do not participate in any Medicare Advantage Plans, so please let us know if you have enrolled in any Medicare Advantage Plan or in any drug plan before you request services.

If you plan to use Parmer County Community Hospital and/or Friona Rural Health Clinic as your hospital and primary care service, before you sign up for any new plan please contact us to determine whether or not you can still receive “in-network” services at Parmer Medical Center and/or Friona Rural Health Clinic and whether your own out-of-pocket expenses will increase. We at Parmer Medical Center and Friona Rural Health Clinic want to continue to serve your health care needs, and we do not want any misunderstanding to occur regarding your Medicare benefits or out-of-pocket costs.

Again, to check on your plan status, please go to MyMedicare.gov or call us at 806 250-2754 and ask for a Medical Plan Check. Call today.