Traditional Medicare vs. Medicare Advantage Plans

Medicare offers comprehensive health insurance coverage to people 65 and older. The decisions and choices beneficiaries face can be confusing and overwhelming. Your basic choice is whether to stay with original Medicare or go to a private Medicare Advantage HMO or PPO.

Open Enrollment for Medicare begins in Oct. 15-Dec. 7. That's when ALL people with Medicare can change their Medicare health plan and prescription drug coverage for 2013. You may receive information from private insurance companies offering a variety of Medicare Advantage plans that are replacements for original Medicare. The vast majority of Medicare Advantage plans are HMOs or PPOs that require you to get your care from a specific local provider network. It’s important to research your options carefully to ensure you receive the full benefits of your plan and care from the doctor and hospital of your choice.

The following is important information about plans that may limit your benefits at Sarasota Memorial Hospital and its network of physicians and services.

Original Medicare vs. Medicare Advantage
Sarasota Memorial ACCEPTS all original Medicare plans and most PFFS (private fee-for-service) plans.

We are NOT in network with most Medicare Advantage HMO, PPO or POS plans – and your service may not be covered or it may cost more out-of-pocket than original Medicare – with or without a supplemental plan – except in emergency situations.

The only private Medicare Advantage plan that Sarasota Memorial and its network of physicians and outpatient facilities accepts at this time is Aetna. We have not approved additional Medicare Advantage plans because, in general, they have more stringent guidelines than original Medicare and are more likely to deny payment on services/claims, while requiring healthcare providers to accept lower reimbursement for services and adding burdensome administrative responsibilities.

We do not believe it benefits taxpayers or our community to accept plans that fail to meet basic standards for adequate reimbursement, timely reimbursement, solvency and access to services. Only 8% of Medicare enrollees in Sarasota County have chosen Medicare Advantage coverage.

Medicare Supplements – Standard vs. Select 
We accept all traditional supplemental Medicare plans (approximately 80% of Medicare enrollees have supplemental insurance). If you choose a “standard” Medicare supplemental plan, you can choose Sarasota Memorial and receive the full benefits of your plan. Your plan will pay the Part A deductible for emergency and non-emergency hospital stays.
If you choose a “Medicare Select” supplemental plan, you can choose Sarasota Memorial, but you will be responsible for the Part A deductible for any non-emergency hospital stay (the hospital does not waive the deductible). Your plan will cover the Part A deductible for any emergency visits. Some select supplemental plans may also make you responsible for your 20% outpatient co-insurance amounts, while standard supplements do not.

For more information about insurance plans accepted by Sarasota Memorial, please call our Customer Service Center at (941) 917-1540.

To learn more about Medicare, visit medicare.gov on the web for a free copy of the “Medicare & You” handbook, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.