Medicare Open Enrollment [transcript] [audio]

Guest: Dr. Jaime Ramos

Presenter: Neal Howard

Guest Bio: Dr. Jaime Ramos is a Family Practice Specialist in Temple City, California and Medical Director with HealthCare Partners, a DaVita Medical Group.  

Segment Overview: Dr. Jaime Ramos, practicing physician and Medical Director of DaVita Medical Group, talks about key differences in Medicare plans this year and offers guidance on how doctors can help their patients find the right resources to choose the plan that best fits their needs.

TRANSCRIPT – Medicare Open Enrollment

Neal Howard: Thank you for joining us here on Health Professional Radio. So glad that you could be here. I’m your host, Neal Howard. Medicare Open Enrollment is in full effect. The period has started. Our guest is Dr. Jaime Ramos, practicing physician and also medical director of DaVita Medical Group and he’s joining us here on the program to discuss some of the differences in medicare plan this year as opposed to previous years and also to offer just a bit of guidance on how practitioners can possibly help their patients to choose some of the resources that best fit their needs when it comes to medicare. Welcome to the program Dr. Ramos.

Dr. Jaime Ramos: Thank you.

N: We do know that Medicare Open Enrollment has started. How long do we have before the enrollment period ends?

R: For most patients in United States, the enrollment period starts October 15 and it ends on December 7. But one thing that’s come up recently from CMS was advising those Americans that live in areas affected by hurricane, that something new, that their changing. Their changing the enrollment period for those populations of patients who are affected by the hurricane in 2017. They extended the deadline which normally ends December 7th. They extend it up to December 31st.

N: Are those the only changes to the open enrollment rules especially as they pertain to hurricane victims?

R: It think to my knowledge, yes. But if you’re not sure exactly, if you pertain, because there’s been a lot of storms in the country, you can go the website www.medicare.gov
and they’ll give you more detailed description and location, somethings like that. They can help clarify that for patients.

N: Especially those patients that we just talked about who had been affected by the recent hurricanes. What about anyone who is either enrolled or planning to enroll? How can they know which plan is best for them?

R: It’s only the complicated decision. Oftentimes patients seek guidance and often they usually go to their providers. So their primary care commission is to help sort of guidance. Even with all the information available, it’s still can be very confusing. Normally you ask permission to check the resources locally and normally like in our organization, we tell patients to consult to our website, http://openenrollment.com and that could give them like a structure sort of who to contact and then a representative can walk them thru the process. I think for clinicians that don’t have that open resource normally there are some several websites and the one I mentioned previously, www.medicare.gov can also help patients. But the challenge Neal is oftentimes you have to understand that some patients need some guidance in regards to some benefits that change. Especially with medicine and transportation and copays often those have been very confusing.

N: As a practitioner you are already involved in taking care of your patient with extremely limited time. Not necessarily resources but extremely limited time. Now you have to find yourself, if I am understanding correctly, versed in medicare plans and how they differ. Isn’t that a bit much, say you can go to websites but if a physician is trying to help and you say traditionally, patients kind of relied on the physician to kind of guide them in such a complicated area that isn’t physically healthcare related. It’s more benefits and interns related.

R: Correct. Unfortunately, as you mentioned time is a crucial thing for clinicians and oftentimes to sit down and we often don’t have the luxury of sitting down. I think for those clinicians that have the resource normally, do want to redirect them to the ones that you trust, that can give some like a balance presentation to patients. A lot of health plans offer sort of seminars and sort of presentation where patients can bring their information and sort of like an informed choice on what benefits might help them. Patients need change every year and patients seem to be aware of different time frames where they can make changes that may be beneficial to them. Or if they like their benefits, at least they may go shop around to see if they can may be maximize what they can earn, what their current enrollment opportunity.

N: How often do patients will throw in the towel and say, “I can’t do this unless you give me this guidance and be hands on.”, because it changes every year. Are we going to have to deal with these changes each and every year for each and every patient with each and every physician?

R: I think the set up, the challenge it is. It can be very challenging to try to do that every year for every patient. Oftentimes, the good news that most patients when they select the initial plan, they’re pretty happy with what the plans deliver. And oftentimes, the normal inertia of the patients is just that not to change, most of them don’t like changing. Very thing is sort of they kind of enrolled, they probably more likely will stay. The guidance comes from the commission where you see over the year. They’ve had some changes in their conditions. Maybe they needed some different types of medication that you need to prescribe or they have higher copay. You have to write a prescription because you think it’s in their best interest. So on the financial side, that’s something we always consider but this is the opportunity where we can say to a patient, “Look, the open enrollment benefit is. We’re in it now. We did change your medication. They’re more expensive. Go shop around. Take a look. See what we can do or what you can do. Maybe reduce your cost because a lot of seniors, some of these are more expensive diabetic medications. Some are the more expensive treatments can be very cost prohibited where you may make choices that don’t serve the best medical interest.”

N: It’s a no-brainer that a person’s medical condition changes, maybe he gets better, maybe he gets worse, they age. Why do think that it is, just because people’s conditions change which they are going to, why is that the benefits change and the enrollment condition’s change every year? These diseases are what they are. Why can’t the benefits remain what they are? Is it all about the money, or is it about trying to better take care of patients?

R: Certainly, we live in a very large country in different climates, different issues happening around them and different resources. What you can find in North Dakota is different than what you’d find in Southern California. A lot of health plan sort of negotiate their rates with their hospital partners, their medical groups and their local areas. And mouthful of resources are different, right? You can see some variability and cost and plans are trying to compete too. You have different health plans trying to compete to provide a better service and now the consumers has to make a decision based on what they’re offering in regards to service. Very popular and most plans especially for like seniors or like transportation benefits. Plans that cover optical care especially when issues are copay, are a matter of considerations. It is a competitive market and often they try to get an advantage by maybe perhaps changing prices but sometimes prices also can affect the level of benefit overtime for a patient.

N: Where is the good resource that patients, caregivers and practitioners can go and get more information?

R: Surely education is a big one. I think the largest one you can seek is through the federal website at www.medicare.gov or if you’re in our different areas of healthcare partners, we give you the medical group. We have our own portal as well, http://openenrollment.com.

N: Thanks for coming in today. Always a pleasure, hoping that you’d come back and speak with us again in the future.

R: Thank you very much. Have a good day.

N: You do the same. You’ve been listening to Health Professional Radio. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. Subscribe to the podcast on iTunes, listen in and download a SoundCloud and be sure and visit our affiliates page at hpr.fm.

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