The Nebraska Hospitals Association hosted the press conference with representatives from hospitals across Nebraska speaking about what they are seeing in regards to Medicare and Medicare Advantage.
We're about to enter Medicare's annual open-enrollment season, under which most of our elderly neighbors will have to make some important health care decisions. It launches Oct. 15 and lasts until Dec. 7.
Some seniors will choose traditional Medicare, under which the government covers most hospitalization costs. Typically, its enrollees also purchase Medigap insurance for doctor visits, outpatient procedures and medicines that Medicare doesn't cover.
Alternatively, some will choose Medicare Advantage, which is basically Medicare administered by for-profit insurance companies that are paid by the federal government. Those insurance companies heavily advertise their Medicare Advantage plans to seniors. And on the surface those plans seem like attractive options.
Typically, no additional Medigap insurance coverage is necessary with Medicare Advantage. Often, Medicare Advantage is free, with no-monthly out-of-pocket cost for enrollees. And usually, Medicare Advantage plans promise to cover some ancillary health services such as dental and vision for little-to-no out-of-pocket by the patient, too.
But sometimes those services can be difficult to access. Andy Parker of Collinsville is a case in point. Since January, the 71-year-old has tried to find an in-network Medicare Advantage dentist for a checkup and teeth cleaning. Parker says he's been stymied at every turn.
When Parker turned 65, he signed up for a Medicare Advantage PPO plan through Humana, and for the next five years he said he was mostly satisfied with that plan. But last fall during open-enrollment, Parker switched his coverage to a Sentara Medicare Advantage HMO plan, because it was offering a $100 grocery card to enrollees.
The Sentara plan offers dental care through a network of dentists known as DentaQuest, which is owned by an insurance company, Sun Life. Parker's Sentara coverage began in January. And that month, he chose Aspen Dental in Danville from DentaQuest's list of participating providers and made an appointment for a cleaning and checkup in March.
Shortly before that appointment, Aspen Dental contacted Parker and informed him it didn't accept his Sentara plan, even though DentaQuest lists the practice as in-network. So Parker canceled the appointment.
In April, Parker tried again. He got an appointment -- for August -- with Collinsville Dental, another listed DentaQuest provider. Then Parker learned he could get an earlier appointment at another DentaQuest provider, Aspen Dental in Roanoke. He said made one there, too.
In June, both offices contacted Parker and informed him they didn't take his DentaQuest dental insurance. At least one office told Parker they accepted DentaQuest Medicaid plans, but not DentaQuest Medicare plans -- and Parker's is the latter.
Oddly, Parker noted, whenever he has called DentaQuest while trying to find a dentist, the company's automated phone attendant recognizes his phone number and informs him, "you're overdue for a teeth-cleaning," Parker said. It's almost as if the robot is teasing him, he added.
"It's gone from the ridiculous to the sublime," Parker added. "They try to make it as hard as possible to get care."
Mike Kafka, a spokesman for Sentara, told me he couldn't discuss Parker's health care with me "due to privacy restrictions."
"I'll refer you to DentaQuest, Sentara's Medicare Advantage Dental vendor, for specifics on their network," Kafka added.
At DentaQuest, I connected with Farrah Phillipo, Sun Life's public relations director.
"Our network has more than 70 providers accepting new patients within 50 miles of Collinsville for Sentara Health Plan Medicare Advantage," she wrote in an email. Phillipo included a link to that list.
It was the same list Andy Parker has plumbed, unsuccessfully, since January to try to arrange a teeth-cleaning appointment.
Some of the offices on DentaQuest's list are community-based health clinics that treat the uninsured. Many others -- such as Collinsville Dental and Aspen Dental -- are dental practices where Parker made appointments, only to later learn they wouldn't accept his insurance.
Both Kafka and Phillipo said they couldn't divulge more information without written permission from Parker. Parker sent a signed release to each, allowing them to discuss his dental care with me, and copied me on those.
But that didn't result in either company divulging any more information Wednesday about Parker's insurance plan or his travails finding an in-network dentist.
I also asked Phillipo if DentaQuest could call Collinsville Dental on Parker's behalf, and inform its staff that they are indeed a DentaQuest provider, so that Parker could get a covered appointment there.
Phillipo replied she had reconfirmed those offices accept Parker's insurance plan "and that our provider engagement team has reached out to the offices to ensure the staff is aware."
Parker said he reconfirmed Aug. 2 that those offices do not accept his Sentara insurance.
The last person I consulted on this matter was Shannon Abell of Roanoke, former director of senior services for the Local Office on Aging. Though retired, Abell still conducts seminars for seniors as a community educator with the Virginia Senior Medicare Patrol.
Almost without exception, Abell said he recommends seniors choose traditional Medicare over Medicare Advantage.
"Medicare Advantage is a disaster, and the bad news is, seniors don't know it," Abell told me, "They're falling for these ads on TV. I warn people in my seminars to stay away from Medicare Advantage plans."
Abell said health care providers for Medicare sign contracts with the government agency guaranteeing they'll accept Medicare enrollees. But health care providers for Medicare Advantage plans sign no such binding contracts, Abell added. Those providers "can drop out at any time during the coverage year," he added.
"Most dentists won't accept these Medicare Advantage plans. That's what (enrollees) in Medicare Advantage face. They're told they get all these great benefits, but it's going to be next to impossible to access them," Abell said. "The ads on TV fool you."
The fine print on every one of those ads, which flashes momentarily on the TV screen, notes, "All customers may not qualify for all benefits; all benefits may not be available in all areas," Abell said.
Parker said his unsatisfactory experience with Sentara's Medicare Advantage plan has persuaded him to switch to another insurer in the upcoming open-enrollment period. He believes that's the only way he'll ever be able to get a covered teeth-cleaning appointment.
Abell's next upcoming seminar, which is no-charge, is about scams that ensnare seniors, and upcoming changes to Medicare Part D. That's at 2 p.m. Oct. 3. in the residents chapel at Friendship Retirement Community on Hershberger Road.
Also, in the near future, Abell will lead four other upcoming seminars that are all about the ins and outs of Medicare.
One's an online webinar at 1 p.m. Nov. 12 offered through Virginia Tech. Members of the public can access that online at: alumni.vt.edu/events/2024/11/cornerstone-chat-medicare.html - advance registration is required.
Here's the schedule for the other three in-person events:
1:30 p.m. Nov. 14 in the main sanctuary of Thrasher Memorial United Methodist Church in Vinton.2 p.m. Nov. 18 in the residents chapel at Friendship Retirement on Hershberger Road.10 a.m. Nov. 21 at Roanoke County's South County Library on Merriman Road.
Dan Casey (540) 981-3423
@dancaseysblog
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