BROOKINGS — “As of 2024, Brookings Health (System) will no longer be in network for any Medicare Advantage plan.”

That’s a key point in a mailer — “An Important Message About Medicare Advantage Plans — sent from BHS Chief Financial Officer Melissa Wagner to the area’s Medicare-aged population, those Brookings County and surrounding area residents aged 63 or older.

Wagner also noted in a meeting on Aug. 3 with The Brookings Register that BHS is reaching out to the area’s insurance agents who sell Medicare Advantage plans, “so that they know and everybody knows that we aren’t going to be in-network with those providers in 2024.”

“There is a difference between traditional Medicare and Medicare Advantage,” the CFO explained. “While (MAs) treat and help the same population, they are different plans and we’re trying to make sure that our community knows there is a difference.”

 “It’s (MAs) taking that government payer and privatizing it,” Wagner added. “I don’t know all the ins and outs of how their business plan works. But basically the government is giving them a set amount of money for whoever signs up for their plan to manage their care.”

 “You’re still entitled to all the same types of services: inpatient, outpatient testing. Actually, they (Medicare Advantage plan) offer usually more: vision, dental, I’ve seen even reimbursement to health centers and things. It’s just knowing all the ins and outs of the plan.

“With Medicare you know that they take a little bit out of your Social Security; they pay the premiums; you know what your deductible’s going to be if you have to use services.”

Wagner noted that some MA plans pull if people with their “no-premium” pitch: “You’re not going to pay for this plan at all until you use it. And now there might be more out-of-pocket costs. It commercializes, … privatizes” your health insurance with an insurance company.”

“Another key difference, too, is the network of providers,” Julia Yoder, BHS director of Marketing and Public Relations, explained to the Register. “They (MAs) have a narrow network to help control their costs.

“So maybe your primary care provider wants you to see a certain specialist. That certain specialist might not be in-network; so then you have to see a different specialist who is in-network.” However, if the patient then sees an out-of-network provider whose fee is higher, the patient might have to pick up part of the cost of that out-of-network rate.

Know your needs

“You have to know the (MA) plan you’re choosing,” explained Sarah Doom, BHS business office supervisor, to the Register. “You need to know: What are your out-of-pocket (costs)? What are your deductibles? What are your co-pays? What is your insurance? What are your health issues and what do you need covered?

“A lot of these (plans) will also pull in a part D, which is pharmacy. What drugs do you have? Are those drugs covered?”

While all Medicare Advantage plans are somewhat generic nature they may have differences that consumers need to be aware of. “Absolutely,” the CFO noted. “And not even from carrier to carrier; but the carrier itself will have numerable plan options.” For example: higher-deductible plans vs. lower deductible plans, which can affect how much premium the consumer pays.  

 “Because of that, people who have those Medicare Advantage plans they need to be thinking about how might that affect their out-of-pocket expenses when they’re choosing a plan,” Yoder added. “If they have traditional Medicare, which we will be in-network with, everything will remain the same. So it’s important that they explore their options and understand what that might mean for their care.”

By way of general information for Brookings area residents, Yoder explained: “A lot of times people will ask us, so are you Avera or are you Sanford? Part of the reason that we’re doing this, too, is because we’ve been city-owned for almost 88 years now and we have to look out for the fiscal responsibility of Brookings Health System to remain a going concern for this community, because we are a community hospital and health system. That’s what it really comes down to.

“That’s another part of the reason why we’ve made this decision: so that we can remain being a sustainable entity to take care of our population, to providing that five-star, compassionate, personalized health care day in and day out.”

Get educated about Medicare, MA plans

The BHS mailer notes that: “Brookings Health is not authorized to assist with Medicare enrollment decision. We encourage you and your family to try to understand the complexity of Medicare and the different options available.” The mailer has a comparison chart that should prove helpful. And several websites are noted where additional information may be obtained.

Also noted is that on Sept. 13 and 27 at Brookings Hospital, a free presentation on “Understanding Medicare” will be given by SHINE (Senior Health Informationand Insurance Education). Covered in the presentation will be: Medicare basics, how to enroll, and the differences between the several parts of Medicare.

The various sources for self-education on Medicare and MAs will help consumers make an informed decision during the 2024 Medicare open enrollment period, Oct. 15-Dec. 7, 2023.

A final note closes out the mailer: “If you have questions about your current plan, we recommend you contact your insurance agent or call the number on the back of your insurance card.”

Contact John Kubal at jkubal@brookingsregister.com.