Published on August 17, 2021

‘Round and ‘round we go with Medicare woes

By Edward A. Forbes / The Bulletin

I I found myself in the middle of the battle between UTMB and Aetna.

I waited until June to act on the information that UTMB would no longer accept Aetna, effective July 1, 2021. I have a Medicare Advantage Plan administered by Aetna and have had it since October 2015.

Aetna Advantage Choice PPO Medicare has been great for me. Drug coverage is included in Advantage plans. My out-of-pocket expense has been $2500 or less, including Medicare cost each year.

I had switched providers to UTMB for several reasons. UTMB’s “My Chart” is a wonderful tool. I can get lab results before the doctor has a chance to review them and can grant access to my online medical information to doctors outside of UTMB’s system. It’s a great tool for patients and doctors alike.

I called UTMB and asked about the state of negotiations with Aetna. A helpful voice told me: “You are correct. We will no longer accept Aetna Insurance after July 1.“

I inquired further: “Does UTMB accept any other Medicare Advantage Plans?”

I was connected to another person. “UTMB, how may I help you?”

I replied: “Does UTMB accept any Medicare Advantage Plans to replace the Aetna plans?”

I was provided two AARP United Healthcare Plans. I then went to the Medicare.gov website to look at plans. The first hurdle I encountered is that only one of the plans is available in our area.

Medicare plans are not statewide but cover regions within the state, and you can confirm availability by zip code. (It’s not just for mail anymore.)

I looked at the plan, and the projected yearly cost is about $1000 more than I am currently paying.

I looked at all available plans in our zip code and found that adding a Part D (drug plan) to any of the more traditional Medicare Plans will add significantly more cost due to higher plan costs, deductibles and drug coverage restrictions.

I chose the AARP Advantage Plan and compared it with two plans without drug coverage.

Woe is me! The new improved Medicare.gov site doesn’t appear improved to me. When I tried to verify that the doctors I am currently seeing accept the plans, it was terribly cumbersome. It seems only one doctor at a time can be verified, and not all UTMB doctors accept all plans that the hospital approves.

I called UTMB again. “Is it unusual for UTMB physicians to not accept Medicare Plans that the hospital accepts?”
There was no hesitation or phone transfer this time. “You will need to contact the doctor to verify coverage.”

This was not the answer I wished to hear. Almost anyone that has undergone surgery or a medical procedure requiring anesthesia can testify to the fact that many anesthesiologists accept no insurance coverage, but they do take cash or credit cards. This is a good point to remember before undergoing any elective procedure.

My next phone call was to Medicare. “Hello, my name is Eddie Forbes. My date of birth is such and such,” and then I answered questions about other relevant information. I further explained the nature of my call.

UTMB and Aetna have reached an impasse, and they will no longer accept my Aetna Medicare Advantage Plan, I’m told. I asked if I can change to a plan they accept.

“You can not change plans just because your provider will no longer accept your Medicare Plan. You can only change during the enrollment period or if you move.”

This wrinkle hadn’t even occurred to me. I now have to find new doctors and a hospital. I chose Aetna not only because of price, but because I had doctors and a hospital within a 10-minute drive from my home, all figuratively speaking, under one roof.

This convenience is gone - poof - vanished.

I have chosen a new primary care physician and have an appointment in October.

So fellow septuagenarians, unless you are in an employer- or union-sponsored medical plan that chooses the Medicare Plan you participate in, you (or a family member or agent) must deal with the Medicare.gov less-than-friendly website to determine if your doctor, hospital, specialist and medications are covered under any plan you choose.

The deductible for drugs and separate deductible for medical are outlined in each plan.

Does the plan cover in-network and out-of-network doctors? (Out of network means higher fees.)

Do you need a referral from your doctor to see a specialist, and what is the co-pay for a specialist? The process is not unlike the violent video games the younger folk play.

Rest up because October is approaching like a freight train.

(Edward Forbes wants to hear from you. Email him at eforbes1946@gmail.com or send comments by snail mail to The Bulletin, PO Box 2426, Angleton TX. 77516.)