If you are going to enroll in a Medicare advantage plan, here are a few tips for making sure your plan works smoothly for you.
Meet your Primary Care Physician (PCP).
Most Medicare Advantage plans (especially in Arizona) are HMOs and require you to pick a Primary Care Physician (PCP). If you are picking a new PCP, you should make an appointment with him or her as soon as possible. When you call to make that appointment, you will probably be given a date that is one to two months away.
If you are enrolling in a Medicare Advantage plan now, but your coverage won’t start for one or two (or three) months, you should call now to set up your PCP appointment. If you call now, your appointment with your new PCP should take place soon after your Medicare Advantage plan coverage begins.
Once you have established a relationship with your PCP, subsequent appointments do not generally require much of a wait. Doctors seem to have a system where they keep open slots for established patients who need to see them in the next day or two. I’ve tried to help clients who needed to see their new PCP as soon as possible and found that exceptions to the scheduling system are rarely made.
Referrals are required.
If you are enrolled in an HMO Medicare Advantage plan, you must get a referral from your PCP in order to see a specialist. If you haven’t yet met your PCP, but suddenly you have a health issue, it might be difficult to get a referral from your PCP. If your PCP has never met you, she is going to be reluctant to write that referral….but she can’t see you tomorrow because of the scheduling system I mentioned above.
If you have a relationship with your PCP, she can refer to your records and her notes when you ask for a referral. In this case you can call and ask for a referral and your PCP will take care of it quickly. You might not need to see your PCP. The office staff will ask if you want the referral sent tot the specialist, or if you want to pick it up.
Make sure the specialist is in your plan’s network.
You can tell your PCP which specialist you’d like to see, or you can leave it to your PCP to pick the specialist. To be sure the specialist is in your Medicare Advantage plan network, you can call that doctor’s office and ask – or you can call the Member Services number on the back of your plan id card. If you go to a doctor, or lab, or facility outside your plan’s network, you will end up paying the full bill.
Labs can be tricky.
Most Medicare Advantage plans contract with just on lab company, even though there might be two lab companies in town. But you can only use the lab that is contracted with your plan. Make a mistake and go to the wrong lab – and you will pay the price.
This happened to a client of mine a few years ago. His doctor gave him an order form for expensive diagnostic blood tests. The form was for Lab Corp and my client went across the street and got the tests. He says he showed his card to the clerk, and the clerk never told him his plan was not contracted with Lab Corp. He ended up with a $300 bill because his plan said he went “out-of-network”.
Don’t avoid the doctor.
Many people turning 65 are very healthy, and they enroll in a Medicare Advantage plan because they rarely go to the doctor. They don’t like going to the doctor. But take my advice: See your PCP as soon as possible and get connected to him or her. If you take this simple step, your Medicare Advantage plan will work smoothly for you when you have a medical issue. Don’t take this step and things could get complicated if you get sick.