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MARIETTA — A local health care company has provided tips on how to choose a Medicare Advantage Plan.

“The reader can use this article to optimize their best suited plan choice that will provide needed future care with as little hassle as possible,” Randall Mason, president and CEO of The Marden Companies of Marietta. “It guides the reader with a step-by-step checklist in talking with local providers to determine which plans reliably support patient care and which delay, deny, or underpay providers. Calling a few providers to ask which plans they work well with can tell the reader more than hours of online research while providing much needed clarity in a very confusing arena.”

The Marden Companies is a regional operator of home health and rehabilitation agencies and contract therapy services since 1984.

Medicare Open Enrollment is currently underway.

When choosing a Medicare Advantage plan, most people focus on price and extra benefits such as gym memberships, dental or a prepaid card for groceries, Mason said.

“But the real test of a good plan is whether you can actually get medical care when you need it, with as little hassle as possible,” he said. “Unfortunately, that’s less common than many people realize.”

The core issues with Medicare Advantage come from how the system is designed, Mason said. Unlike traditional Medicare, which pays providers directly for covered services, Medicare

Advantage plans are run by private insurance companies that receive a fixed monthly payment for each enrollee, a payment that doesn’t automatically go up just because someone needs more care, he said.

“This structure gives insurers a strong incentive to control costs,” he said.

Costs are often controlled through narrower provider networks, prior authorization requirements and lower payment rates to providers. Such tactics could make it difficult for beneficiaries to find providers who accept their plan or to get approval for services like home health or skilled therapy.

“Plans often attract members with extra benefits and low premiums, but may limit access or underpay for actual medical care to stay profitable,” Mason said. “That’s why some plans look excellent on paper, but become frustrating when serious health needs arise.”

Talking to providers matters more than people think, he said. Two Medicare Advantage plans can have similar premiums, ratings and marketing, yet behave differently when it comes to approvals, payments and how they treat care, according to Mason.

Such differences usually do not appear in brochures, ads or most broker conversations, Mason said. The people who see the real story are doctors and clinics, home health agencies, hospitals, skilled nursing facilities and inpatient rehab centers.

“They know which plans pay reliably and support patient care, and which delay, deny or

underpay,” Mason said. “Calling a few providers to ask which plans they work well with can tell you more than hours of online research.”

By talking to providers, consumers can learn:

* Who actually takes the plan. A plan may list a provider as in-network, but that provider may have stopped accepting new patients from that plan due to poor payment or excessive denials.

* Which plans pay promptly and fairly. Slow or low payments drive providers away. If providers won’t work with a plan, members suffer.

* Which plans have the most and least prior authorization requirements. Providers can tell you if they’re constantly fighting for approvals for home health, rehab, imaging or hospital or skilled nursing facility days.

* How often patients run into denials or shortened stays. If a plan routinely cuts rehab stays short or second-guesses medically necessary care, staff will know.

As a step-by-step checklist, Mason recommends consumers choose three types of providers to call and focus on areas where access and authorizations matter most: home health agencies (ask for intake or billing); skilled nursing or inpatient rehab facilities; outpatient therapy clinics; local hospitals; large physician groups; and personal doctors.

If using high-cost medications, ask the pharmacy about prescription drug reimbursement for any plan chosen.

Mason also provided scripts, samples that the beneficiary can use when asking questions.

They are:

“Hi, I’m a Medicare beneficiary shopping for a Medicare Advantage plan for next year. I’m not asking for advice on buying insurance. I just want to know which (Advantage) plans you like working with, and which ones you avoid because they don’t pay well or make it hard for patients to get care.”

Then ask:

* “Which plans are easiest for your patients to use?”

* “Are there any plans you no longer accept, or that make home health or rehab difficult?”

* “If I needed an inpatient stay or therapy, which plans tend to approve what you recommend?”

Write their answers. If several providers say the same plan is difficult, believe them.

Cross-check responses after calling three to five providers:

* Look for patterns such as repeated praise or warnings.

* Compare star ratings on Medicare.gov, focusing on getting needed care, member complaints and appeals.

Eliminate problem plans. Cross a plan off if providers consistently report that it:

* Pays too little or too slowly.

* Denies common, reasonable services.

* Requires excessive prior authorization.

* Has recently lost major hospital or system contracts.

No matter how attractive the extras sound, access to real care comes first.

Confirm a shortlist of plans. For the remaining two to three plans:

* Confirm what doctors, hospitals and pharmacies are in-network.

* Review each plan’s prior authorization list on the insurer’s website.

* Choose the plan that offers broad access, reasonable rules and that providers say “works.”

“The bottom line is Medicare Advantage plans are not all the same,” Mason said. “The best plan isn’t just the cheapest. It’s the one that pays providers fairly and lets you receive care without a constant fight.

“Providers are on the front lines every day; their experience is your best window into how a plan truly performs,” he said.

Marden can help, Mason said. Before enrolling, make the phone calls, he said.

“It’s one of the simplest, most powerful steps you can take to protect your future care,” Mason said. “We’re here to help.”

For more information, call (800) 827-9682 or email contact@mardencompanies.com. The website is www.mardenrehab.com.