Help patients understand their Medicare coverage

Medicare co-pays may be higher

Helping patients understand their Medicare coverage in the wave of alternative plans that are being offered is a service that all patient access employees should be prepared to provide, suggests Keith Mueller, PhD, director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis at the University of Nebraska Medical School in Omaha.

"What I've heard has been happening lately is that people will sign up for Medicare Advantage plans, not realizing that they have just changed everything about their coverage from what it was before," Mueller says.

"Before, there was a minimal copayment, now there may be a larger one," he adds. "Under traditional Medicare, it may not matter where you go [for care], but under Medicare Advantage, it may cost more depending on where you go."

However, discussing this issue with patients, can lead to "a real sensitive area of counseling," Mueller points out. "You don't want to say, 'It costs more money for you to come here than to go [to the hospital] down the highway.'"

Instead, he recommends the access employee say, "I see that with the coverage you had before, there were no copays, but now you're responsible for $1,500. It might be less if you go to a different hospital."

At the same time, he says, "you don't want them to get the idea that there is a difference in care quality at the other hospital."

Mueller, who works as an advisor on Medicare issues, says the "Important Message From Medicare" that patients are given "doesn't make that clear. This particular issue hadn't even appeared to me until recently."

Mueller notes that one of the challenges with communicating this and other messages at the small, rural hospitals with which he works is that staff don't have the support systems to draw on that exist at larger facilities.

"In talking with the press about small, rural hospitals, they complain that they can't get patient condition [reports]," Mueller says. "The problem is those hospitals don't have the resources to maintain their own legal staff and expertise so they can have a high degree of confidence that they are doing the correct things under the law."

They realize, he adds, that there could be civil and criminal penalties associated with not doing the right thing.

His advice to staff at these hospitals is to talk to their peers at comparable facilities. "Ask, 'Is someone in my state doing this differently?'"

During visits to rural hospitals, Mueller says, he often finds that something innovative is happening in a particular area at one facility, while 30 miles down the road, another hospital is struggling with the same issue.

"They don't talk to one another," he adds. "This is where networking activities [should] come into play. Ask your state association for help."