Providence doctors suggest Part C plans have something for everyone

Dr. James Benoit is a man palpably passionate about the long-term relationships he can develop with Medicare Advantage beneficiaries as their primary care physician. As president of Orange County's St. Joseph & St. Jude Heritage Medical Group, he's able to enhance this continuity of holistic care through its network of world-class specialists and facilities.

“I’ve been practicing [in Orange County] for about 30 years,” Benoit explained. “So I have connections and friends that are within my medical group… You can obtain the highest level of care in any number of fields from within that organization.”

St. Joseph, St. Jude and Mission are affiliated with the long-established, multi-state Providence. This provides another layer of convenience and reassurance for Benoit's Medicare Advantage patients.

"The values that they carry in providing care are very, very similar [to St. Joseph & St. Jude's]," said Benoit. "They've helped us to grow, with the kinds of technology and things that we really didn't have as much before. Technology's made a huge difference."

Medicare Advantage

Medicare Advantage is a heaIth insurance plan that provides Medicare benefits through a private-sector insurer. Beneficiaries receive coverage for Medicare Part A (inpatient hospital) and Part B (out patient) services, and typically also for Part D (prescription drugs). Such plans also include additional benefits like annual physical exams, dental and/or vision coverage, and gym membership. Transport to medical appointments, adult day care, and assistance for daily living may also be covered.

The best-of-all-worlds scenario described by Benoit - the personalized app roach of an experienced primary care physician harnessed to a comprehensive medical group and backed by a major healthcare system - is exactly what many Medicare Advantage plans deliver.

"You have your advocate - your primary care doctor; your best friend - who's going to manage your care, and then refer you out to the appropriate sub-specialists if need be," said Dr. Rudo Benjamin, a board member at Providence Medical Associates in Torrance. "And then, just make sure everyone's in communication with one another ...That's just as important, that continuity of care and communication."

A Medicare Advantage plan, especially one affiliated with a major healthcare system, can truly live up to its name.

Enrollees can enjoy lower overall costs while enjoying high-quality and extremely comprehensive care.

Cost

Despite their array of additional benefits, Medicare Advantage plans can offer cost savings compared to Original Medicare.

Because private insurance companies are competing for business, they offer low-or zero-premium Advantage policies (though you'II stil I have to pay your Medicare Part B premium). Additionally, they manage their costs contracting with networks of doctors and hospitals, and pass these savings along to beneficiaries.

"Traditional Medicare usually only covers about 80% of your health care costs," said Benjamin, an Internal Medicine Specialist with over 23 years of experience. "So most people will need to get some sort of supplemental coverage."

The preventative care and disease management programs offered by Medicare Advantage plans mean healthier patients, which further reduce costs. And zero copays for primary care visits encourage patients to see doctors before a medical issue gets serious (and expensive).

"Even a small amount [of copay] is a hindrance to patients seeing doctors," said Benoit. "We don't want a hindrance; we want to make sure if people need to be seen, that they're seen."

Depending on the plan, you may still have to pay some deductibles and copays, but these plans also offer greater predictability of expense, and include an annual out-of-pocket spending limit crucial in cases of illness or catastrophic accident to avoid overwhelming bills.

Flexibility

So why does anyone stick with Original Medicare? Most do so because of the perceived flexibility of that coverage. With "traditional" Medicare you can choose any primary care doctor and specialists who accept Medicare. And you don't need referrals to see medical providers.

By contrast, under Medicare Advantage you'll essentially be joining a private insurance plan like those offered by employers. But these insurers can offer one-stop advantages that Original Medicare cannot.

Medicare Advantage plans with comprehensive medical groups like Providence Medical Associates offer access to alI of the services that most patients will ever need. When these groups are affiliated with vast healthcare systems like Providence, which operates multiple hospitals across eight states, they deliver even greater choice.

Medicare Advantage in 2021

As we head into an unpredictable 2021 for healthcare, a Medicare Advantage plan with Providence, which is sufficiently experienced and resourced to rapidly respond to changing conditions, could prove all the more valuable. For example, Providence medical groups were able to rapidly and effectively pivot to telemedicine when social distancing became a requirement back in March.

"The cost of getting the training, the equipment, the licenses, the infrastructure to go along with that would have been exceedingly difficult, if not impossible," said Benoit. "Being a part of a large organization allowed us to do that flip and get back to taking care of people."

—Paul Rogers, Custom Publishing Writer