Medicare vs Medicare Advantage – Key References
For AR-BID members living in the U.S.
In the wake of an aggressive publicity campaign recently carried out by Medicare, we have been receiving numerous inquiries about the “Medicare Advantage” plans and what the corresponding benefits would be for our retirees. With this email, we hope to provide you with key resources for you to understand the differences between Medicare and Medicare Advantage and ultimately make the decision that is best for you.
Every year, Medicare publishes Medicare and You (this document is also available in Spanish “Medicare y Usted”). The 2022 handbook is extremely useful in helping to understand the difference in coverage under traditional or original Medicare and under Medicare Advantage. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week.
As a reminder, the IDB requires that all retirees and their dependents, living in the United States, upon reaching 65 years of age enroll in Medicare. Participation is mandatory. As a result, Medicare becomes the primary provider, and the administrator used by the Bank, currently Aetna, becomes the secondary provider. The Medicare premium, as well as its deductible, is reimbursed by the Bank, and Aetna covers expenses not covered by Medicare, which means 100% coverage of claims as long as the providers participate in the Medicare and Aetna networks. The IDB International Program Handbook of Medical Benefits explains the coordination of benefits between Medicare and our secondary provider. Please note that if the retiree (or his/her dependent) fails to register for Medicare while being eligible to do so, all medical expenses incurred must be paid by the patient and will not be reimbursed by the plan.
Medicare Advantage is offered by private companies approved by Medicare, who establishes the rules for their implementation. Anyone interested in these plans should read the Medicare manual carefully, as they contain very specific restrictions not mentioned in the advertisements. These programs are independent and work separately from traditional Medicare. Advertisements on television and in print do not provide the necessary information for decision making.
Another source of information is the AARP (the American Association of Retired Persons). Its October 2021 newsletter, spells out the differences among the plans offered. Among the critical issues that must be evaluated when considering alternatives to the use of Medicare include: i) many of the providers are HMOs with restricted coverage and only based on medical necessity, ii) the plans only cover the individual while in his/her place of residence since the Medicare Advantage provider networks do not provide national coverage.
Please take the time to read the information to ensure you are protected!