Which to choose? Medicare Advantage or Medigap?

by KATE SERODIO, DPT

It is that time of year again; time to pick your Health insurance plan! The question is, will you opt to stick with your Medicare and Medigap (supplemental Medicare plan that fills in the ‘gaps’) or change to a Medicare Advantage Plan.

The first thing you will want to ask yourself is:

  • – Do you want to be limited in which providers you can go to?
    – Do you travel? Do you reside in another state for any length of time?
    – Do you want to have to get a referral to see a provider?
    – Do you want to pay a copay each visit or deal with high deductibles?

If you answered No to any of these questions, then a Medicare Advantage plan is most likely not a good fit for you! Recently, we have seen a big increase in the number of Medicare Advantage plans and I wanted to share a story that represents the Physical Therapy experience of many of our Medicare Advantage patients…

Last December (2019), Jenny referred herself to Physical therapy for her hip pain that was not getting better after a couple weeks of rest. She had already met her MC insurance deductible of $185 and had a supplemental insurance, which resulted in no cost for her to have PT. She had previously been to PT and was aware that she could come in without a doctor’s referral. She enjoyed the direct access as this saved her a trip from having to see her primary. We treated her for a couple weeks prior to the end of the year. Jenny returned after Jan 1st 2020 for continuation of her PT. She presented her new Medicare advantage card thinking her benefit would be similar to her traditional Medicare plan. Unfortunately, Jenny’s new Medicare Advantage plan now required her to get a referral for therapy. She was frustrated with this change, as she had enjoyed the ability to book directly to PT and other specialists. Her frustration grew larger when she was told she now had a $40 copay for EACH visit! She quickly commented, this Medicare Advantage plan seems more like a disadvantage plan!

As the year of 2020 has continued, we have seen patients like Jenny again and again, making the same comment, “My Advantage Plan seems like a disadvantage from the traditional plan and supplemental plan I previously had”. As a physical therapist, I have been treating patients with Medicare for many years. For years, our patients came in and their plans were very straight forward and easily managed. Until recently, we had nearly a 100% of our patients with traditional MC plans along with supplemental plans. Suddenly, as of 2020 we had approximately 10% of patients change their plans to a Medicare Advantage Plan. We had several patients try to schedule visits directly with PT, however we had to refer them to see their PCP first. NH is a direct access state and you do not need a referral to go to PT, UNLESS your insurance requires it. MC traditional plans do not require this, however most Medicare Advantage plans do. We have also had several patients choosing to not have their PT due to the reoccurring copay costs, which can add up quickly. Unfortunately, this has resulted in many of our patients not getting the care they would have previously received with their traditional plan + supplemental.

Medicare Advantage plans are very similar to the plans that many people previously had when they were working. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and provide at least the same level of coverage that Medicare Part A and Part B provide. Medicare Advantage enrollment is highly concentrated among a small number of firms.

  • 44% United Healthcare and Humana
  • 15% BCBS affiliates (including Anthem BCBS plans)
  • 23% (CVS Health, Kaiser Permanente, Centene, and Cigna)
  • Benefits of Medicare Advantage Plan:

Medicare Advantage plans include everything that the original MC offers, with the exception of hospice care, and can offer additional benefits such as dental benefits, vision, and wellness programs. Some may cover prescription. Many enjoy a bundled plan.

Medicare Advantage plans have lower premiums (However, Medicare Advantage plans often cover fewer expenses than Medigap — often resulting in more out-of-pocket expenses such as deductible, coinsurance and copays with office visits, Therapy services, lab work, surgery, and many others.

Medicare Advantage plans have a maximum out-of-pocket limit or MOOP. In 2020, the mandatory MOOP for Medicare Advantage is $6,700, although you may find plans choose to set theirs much lower.

Benefits of Medicare Supplemental Plan ‘MEDIGAP’:

Medigap covers you for any hospital or doctor in the US that accepts Medicare (the majority accept Medicare). 

No need for prior authorization or a referral from a primary care doctor. Coverage includes the entire U.S., which may be important for those who travel frequently or spend part of the year in a different locale. This option is ideal for those who have particular physicians and hospitals they want to use.

More security long term. When you first sign up for a Medicare Part A and Part B Medigap, insurance companies are obligated to accept you regardless of your current medical condition. However, if you have opted for a Medicare Advantage plan and then decide to return as your health declines you may not be able to find coverage or you may be charged significantly more due to your medical condition

The main downside of Medigap is that the premiums may be higher than those of Medicare Advantage. If you don’t mind the Medicare Advantage limitations of freedom and if you’re healthy and can predict that you’ll remain that way, then a MC advantage plan may be perfect for you. My primary concern as a provider is when I see people not getting the care they need because they’re worried about the added cost each time they require treatment. Therefore, when it comes to your health, my suggestion would be to have the plan that will add one less stress to your life when you really need it!

To speak with someone in more depth about these options, visit Medicare.gov

Don’t forget, the deadline to choose your plan is December 7th so don’t delay!

Stay healthy and safe!

Kate

RESOURCES:

https://www.thestreet.com/personal-finance/insurance/health-insurance/medigap-vs-medicare-advantage

https://www.pmgmd.com/health-matters/medicare-facts/facts-about-medicare-advantage-plans/

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/

MASKS: Another Hurdle for Businesses to Overcome During Covid-19

MASKS: Another hurdle for businesses to overcome during Covid-19 - Hampton Physical TherapyBy KATE SERODIO, DPT – Owner/Physical Therapist Hampton Physical Therapy & Rezilient

No one is spared personal hardships during this difficult pandemic. From the fear of contracting the virus to the tough convalescence of those who do, not to mention the devastation of losing a loved one to it. There’s so many new adjustments to deal with, like working from home, or being laid off. Having to home-school kids is a huge challenge too. For those of us ‘essential workers’ it’s been extremely trying as well.

As a business owner, I have experienced the complete shutdown of a non-essential business (Rezilient) as well as the struggle of remaining open as an essential business (Hampton Physical Therapy). It’s been nothing but endless hurdles. The struggles of a complete shutdown then reopening is basically like starting a business from scratch. While remaining open during the pandemic with a skeleton crew certainly had its own challenges. From battling with the ever-changing CDC guidelines, to the additional work needed to provide a safe environment, to the laying off /rehiring of staff (with some pushback due to the unemployment stimulus funds they were receiving). Unfortunately, my businesses just aren’t Pandemic Proof.

Sadly, the continued emphasis from patients hasn’t been about how great a service we provide, but instead whether our business is safe and clean and worth the risk. The fear is understandable. Many months into Covid-19 and I still find there is still so much time and energy devoted to this virus, that the true goal of the business has lessened.

As we treat patients and clients daily, there is one other elephant in the room that is hindering us from connecting, yes, the MASK! The mask obviously has its purpose to prevent the spread but it is affecting us on a whole other level, a mental and emotional level. The mask is a constant reminder that we are in a pandemic. When a primary part of a business is about connecting with people, the facial emotional barrier of masks is yet another hurdle that we must overcome.

A huge part of providing a Great service is the ability to connect with people. Whether you’re a greeter, a waitress, a hairdresser, or a doctor you need facial visual input in order to read their reaction to your questions or comments. Their response is what drives the direction of a conversation. The mask in effect, makes you feel as if you’re talking to a wall. Yes, the eyes are expressive, but I’m finding the mouth is what I often check for nonverbal cues as to how my patient is doing. Consequently, this is a huge barrier to business as this is a fundamental of great customer service. What was once transparent is now a guessing game, an added obstacle on top of accomplishing your job.

Since the first day I started wearing a mask back in March while treating patients, I have personally felt less emotion. Perhaps even less empathetic to my patient’s needs. I believe this is because I can’t see their feelings or pain or smile, and I know they can’t see mine, so why bother. The lack of this input easily makes you have less emotion. Not only does this affect the provider but it also affects the client/patient. Research supports this: a BMC randomized control study in 2013 “Effect of facemasks on the empathy and relational continuity” found that “patients perceived doctors who wear masks as less caring and empathetic.”

Another interesting article that supports our struggles with masks and emotions is from Trends Neuroscience Education: “Masked Education? The benefits and burdens of wearing face masks in schools during the current virus pandemic.” This is an interesting article on many levels. One topic they discuss is how the face provides a universal language for communication, in particular, the communication of emotions. The mouth region on a face conveys information that is crucial for smiling, i.e., a positive emotion, which can work as social glue and facilitates positive social cognition and action. Not seeing the bottom half of the face makes it particularly difficult to recognize a mask-wearer’s positive emotions – pleasure, joy, happiness, amusement, sociability, and friendliness – as they are basically communicated by a smiling mouth. Therefore, face masks impair mainly our positive social interactions and our ability to understand, and empathize with one another.

Some other added struggles that the mask unfortunately results in is a muffled voice. Many people with hearing impairment are having an even harder time communicating because of the muffled voice as well as the inability to read lips.masks muffle voices during covid - Hampton Physical Therapy
Many people that don’t even have a hearing problem are finding that they suddenly can’t understand anyone. A number of my patients are misinterpreting what I’ve said, its often like we’re playing a game of telephone where the message is completely distorted by the end of the conversation. Who knows how many people I’ve somehow offended! There are many times that I assume someone didn’t hear me and I go to repeat myself, only to find out that they did hear me but were making a thinking face that I wasn’t able to pick up on. The normal conversation just simply doesn’t flow as it used to or should, leaving a feeling of complete disconnect.

In my line of work, recognizing feelings is extremely important. In a profession where you provide hands on services, you’re no longer able to gauge from their facial expression if you’re physically hurting them. So many cues that we have all become accustomed to are no longer available. The inability to see feelings on someone’s face and the inability to express my own feelings with a smile is a huge hurdle for me and my business.

So, whether you’re a business owner or an employee trying to provide a service, and make sure you’re able to continue to connect with your clients, you need to overcome ‘the mask’. Since March these are some of the things I’ve found useful:

1) Focus on the eyes. Attempt to read theirs and utilize your own when smiling.

2) The mask sometimes feels like the elephant in the room, so just get it out there, and talk about it. Talk about the mask and how it creates a disconnect, people will agree with you and you’ll connect. Having a conversation about how the mask affects your peripheral vision will open up a possible connection. I actually fell off the treatment table because I couldn’t see down. Have the mask be your first thing in common. It will open doors up for further discussions.

Another good topic is talking about all the great things the masks do:

– don’t have to stress about food in your teeth
– if you have bad breath, no one will know
– only need eye make up
– the obvious… less germs spread
– this list hasn’t gotten that long… we all agree it’s short but have a fun time trying to come up with positives-send them my way if you have more

3) Mask fitting: make sure your mask doesn’t hit your lips, this muffles your voice even more and makes it difficult to hear which will complicate connecting even more.

4) Give people a visual of yourself-perhaps a business card with a picture of yourself. This will allow them to feel more connected as they’ll be able to build a mental image of you

5) Wear a clear fitted mask: A clear mask for you would eliminate ½ of the problem. You’ll still struggle getting visual feedback from them, but you’ll at least be able to smile with them knowing and allow for a connection and better communication. This would also assist with someone who often needs to read lips.

*FYI this is not a shield, these do not provide the level of protection most are seeking.

6) More gestures! Air hugs: I used to give hugs, now I tell them I would love to give them a hug but I suppose an air hug will do. Hand Air Shakes: handshakes are definitely out but an air shake and just a big greeting will do. Thumbs up or head nods, all are useful to connect.

9) Discuss the need to Communicate: if you have a business that you need to know if you’re hurting someone, have a discussion about communicating. Make sure they understand their role is to speak up if they’re not happy.

10) Try harder: you have to simply try harder, dig deeper to connect. Know it and own it.

11) Mask messages – purchase one with a smile on it or a positive quote. Believe it or not, this can be powerful and allow a connection.

12) Encourage people to buy clear masks-this will allow us to feel as normal as we can in the present.

We all need to be resilient. We must accept that this is potentially our new reality and you must figure a way to overcome it. Hurdle after hurdle, whether small or big, we must move forward.
I encourage you to Be Rezilient!

REFERENCE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879648/
Trends Neurosci Educ. 2020 Sep; 20: 100138.
Published online 2020 Aug 11. doi: 10.1016/j.tine.2020.100138

PMCID: PMC7417296 Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemic
Manfred Spitzer1

 

Needing a Knee Replacement? What to expect…

After knee replacement - physical therapy at Hampton PTby KRISTIN KEAFER DPT, Hampton Physical Therapy

Osteoarthritis is a degenerative process over time where the cartilage at the ends of your bones starts to “wear and tear”. Many different joints throughout your body may be affected with age related changes and the knee joint is commonly a symptomatic area. This involves the break down of cartilage at the end of the femur (thigh bone) and the end of the tibia (shin bone). Typically, an x-ray and a severe decline of your daily function will determine if you are in need of a joint replacement surgery. In the United States alone, 4.7 million individuals (3.0 million women and 1.7 million men) were with a total knee replacement in 2010.2 Signs that you may be ready for a knee replacement are significant swelling around the knee, tenderness, stiffness, pain with inability to straighten knee, deformities such as knock- knee or bow legged, and severe functional limitations. Physical therapy is the first line of defense to address pain and function, however if conservative methods are not working, it may be time for a joint replacement. All non-surgical treatments will be exhausted before moving forward with a surgical intervention. This can be discussed with both your physical therapist and your doctor.

What is a knee replacement?

The worn cartilage at the ends of the bones are surgically removed and replaced with a combination of metal and plastic implants. Typically, a knee replacement will last up to 20 years, however this can vary based on wear and tear of the components placed. In some cases, the doctor will only replace one side of the joint called a uni-compartmental replacement because the other side of the joint is still healthy. In these cases, the surgery is quicker, hospital stay is shorter, and rehabilitation process is faster.

Pre-Operative Treatment

Pre-op knee replacement - physical therapy at Hampton PT

Usually, your surgeon will refer you to physical therapy for pre-operative treatment prior to your knee replacement. Research indicates that it can improve early post-operative pain and function.1 A physical therapist will evaluate your range of motion at your knee, your strength, and your overall function with daily activities. This will further justify need for the surgery to your insurance company and will allow the therapist to work with you to increase strength and range of motion as much as possible to improve your post-operative outcome.

Pre-operative treatment is unique in the fact that you can meet with your therapist prior to undergoing your surgery to ask any additional questions and learn more about the rehabilitation part of this journey. Many of the range of motion and strength exercises that are prescribed to you before surgery will be similar to those after surgery. This always helps to make you feel more comfortable with what to expect.

Post- Operative Treatment

After surgery, typically you will spend 1-2 days in the hospital. You will work with a physical therapist in the hospital who will help you out of bed and start moving. They will show you how to use a walker or crutches and they will give you some exercises to work on while you are in bed. It is important to move after surgery to avoid a DVT (blood clot). Your plan for discharge depends on how functionally limited you are and what your home situation is like. Sometimes you will be discharged directly to home, and other times you may go to a skilled nursing facility if you need more help after surgery. Once at home, a physical therapist will come to your home to help you. As soon as you are able to safely leave your home, you will transition to outpatient physical therapy for continued rehab.

Outpatient rehab… this is where Hampton Physical Therapists’ are essential in this process!

Post-op knee replacement - outpatient physical therapy at Hampton PT

You should expect your therapist to be working hands on to reduce swelling and pain in the early stages. We also help to properly transition you off of a walker, crutches, and/or a cane to return you to normal walking mechanics. Manual stretching is implemented to improve your range of motion into flexion (bending the knee) and extension (straightening the knee). You will be given exercises to work on in the clinic and at home. It is imperative that you work as a team with your therapist to reach the best outcome. Gradually the focus will transition from range of motion exercises to strengthening exercises to improve all of your functional activities.

Post-op knee replacement - outpatient physical therapy at Hampton PT, Hampton NHBelow are guidelines for reaching functional goals post operatively to get you back to living a normal life!

Reaching Your Goals!

Day 1- 2 weeks
0 degrees of extension and 65-90 degrees of knee flexion. You will be able to stand, walk, go up and down stairs with assistance. Decrease swelling and keep pain under control!

2- 6 weeks
0 degrees of extension and greater than 90 degrees of flexion. You will be able to walk without an assistive device, sit and stand more comfortably, and do stairs with minimal support.

6-12 weeks
0 degrees of extension and 115 degrees of flexion or better. You should be able to move around normally, bend down to pick things up, sit comfortably, stand for longer periods, and tie your shoe laces.

12+ weeks
0 degrees of extension and 115-135 degrees of flexion. The first 90 days are definitive in your recovery. You should have little pain and be able to do most daily activities with ease. You will be working towards walking longer distances and getting back to normal life.

Range of Motion Milestones

0 degrees of extension to walk normal without a limp
65 degrees of flexion to walk on even surfaces
70 degrees of flexion to lift an object from the floor
85 degrees of flexion to climb stairs
95 degrees of flexion to sit comfortably and to stand up from being seated
105 degrees of flexion to tie shoe laces comfortably
115 degrees of flexion to squat or sit cross legged comfortably
135 degrees of flexion to get into and out of a bath tub without limitation

Hampton Physical Therapy is here to help with your journey before and after joint replacement surgery! Please contact us at either our Hampton or Seabrook office with any additional questions or to schedule a FREE discovery visit!

Resources

    • Li Wang, et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016; 6(2): e009857. Published online 2016 Feb 2. doi: 1136/bmjopen-2015-009857
    • Maradit Kremers H, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am.2015 Sep 2;97(17):1386-97. doi: 10.2106/JBJS.N.01141.
    • Rowe PJ, et al. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture.2000 Oct;12(2):143-55.