Drastic changes continue to be made to Medicare and Medicaid which may directly impact the ability to receive healthcare for those enlisted in the programs.
According to Rob Driesel with Diamond D Group, now is not the time for complacency when it comes to healthcare.
“There have been major changes in medicare and a lot of hospitals, doctors offices and pharmacies, the networks have changed drastically. People really need to pay attention right now people on Medicare and especially on Medicare Medicaid.. A lot of them over the last year or two left Medicare supplements or Medicaid and have gone to Medicare Advantage Plans,” Driesel said. “The Medicare Advantage plans have taken a big swing at provider networks as far as what hospitals and doctors you can use. Today in 2023 your hospital or doctor may be in it however, come January 2024, there are a lot of doctors and hospitals making drastic changes of what they’re going to accept.”
Although users may be content with the plan they’re currently in, Driesel warns the changes may leave many Medicade and Medicare patients in shock when changes are made in 2024.
“You may be happy with the plan you’re in, but in January of 2024, you may show up to your doctor and they’re not taking it. Some people have gotten letters and a lot of people don’t read the letters because they’re very technical. So, they look at it and just say they’re fine where they’re at. But you really need to read the letters because there may be changes coming,” Driesel said. “Especially in Sharp County, a lot of the doctors in Sharp County are linked to hospital networks and if the hospital drops it then the doctors have to drop it.”
For those who use medical providers in North Central Arkansas, Driesel said during the enrollment period, one company will include White River Health, NEA Baptist, St. Bernards and Access Medical on the provider list.
“Primewell, is a company we’re a representative for, they accept NEA, St. Bernards, White River and Access Medical and that’s important for the Medicaid Medicare population because typically they go to those doctors and hospitals here locally,” Driesel said. “If they’re going to be in a Medicaid Advantage Program, then they need to be in one they can utilize the doctors of Sharp County. I don’t want them to have to drive somewhere else when they shouldn’t have to.”
Driesel said for those who struggle to navigate the complications and changes, there is free help available to them.
“They can call 800-575-1677 and we can help them. The line stays busy so they need to leave a message and one of us will get back to them. Being content this year is not a good thing because of all of the changes coming in doctors networks. They also need to check their supplement prices because those are on the rise as well,”Driesel said. “Diamond D is an independent company. We represent many companies but also Primewell. We don’t charge to help people. Whether or not they use us is up to them, but we’ll take their phone call.”
Driesel said monitoring incoming mail is also vital at this time as Medicaid is revaluating and missed letters may mean a lost of benefits and access to healthcare.
“Medicaid is doing reevaluations right now and people may not understand they have to fill out these forms they’re getting. They need to fill out those forms. If they get a form and it requires a signature we’ll be glad to walk them through that,” Driesel said. “If they don’t send it in they can lose their extra help with medications. They need to read their mail. I understand they get a lot of it this time of year, but they really need to pay attention to any mail from CMS and Social Security and any letters from their carrier.”
Filling out and returing the forms may mean the difference between assitance to help purchase medications and seeing huge jumps in out of pocket costs.
“They need to get those filled out because they could lose their extra assistance because when January comes, when they go to the doctor they might find out they don’t have medicaid or assistance anymore and then they’ve got these huge co-pays all of the sudden,” Driesel said.
Like many other services, Driesel said scammers are also trying to target recipients of Medicare and Medicaid and warns recipients to be vigilant.
“Medicare doesn’t call you or send you a flier. Anything they get is from a call center and if they ask for your Medicare card, that’s not Medicare, they’re trying to get your number and sign you up for a plan. A lot of people answer those and they shouldn’t,” Driesel said. “Medicare, Social Security or the IRS if they send a letter it’s going to be certified and if medicare sends it it will say center for medicare services on it. It’s not going to say medicare. It’ll say CMS.”
Driesel also warnned to be aware and think before answering any questions from unsolicited parties over the phone.
“Be aware and stop and think before you answer any questions on the phone. A rep can’t knock on the door without permission and people have to make sure they understand unless you invite someone to your home or accept a scheduled appointment they’re (legitimate representatives) not allowed to talk to a Medicare beneficiary,” Driesel said.
For those needing help with healthcare coverage who do not qualify for Medicare or Medicaid, Driesel said Diamon D Group can also help those navigate the market and with the Affordable Care Act.
Lauren is a an award-winning journalist who decided after 10 years of newspaper experience to venture out. Hallmark Times was born.
