How to Choose the Right Medicare Advantage Plan

How to Choose the Right Medicare Advantage Plan

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Bob Powell: One of the things that that we wanted to talk about is this notion of health care and how so many people today are using Medicare advantage for as their medicare plan and maybe you could sort of share your thoughts about why Medicare advantage and some of the advantages of it.

Donato Tramuto: Sure, and I would love to. After 40 years in healthcare, I think that what is unique for me in the Medicare advantage is that they're addressing health care and not sick care. I think the problems in our healthcare system is that we have for too long address sick care. We wait until the individual gets sick and then we put all the resources. What is really terrific about Medicare advantage is that there is this recognition that in any population you have three categories. You have the healthy, you have the stable chronic, and you have the severe chronic. Historically, you always said to yourself, you're stuck with a severe chronic, throw all the resources when they get sick and take care of them. Stable, chronic, will wait until they get sick and the healthy, well, we'll hope that they don't go into that middle category. ,What I like about Medicare advantage, it's really an offshoot of a managed care plan, is that all three categories have to be managed. How do you keep the healthy healthy, which is why our Silver Sneakers program is now been the flagship of a Medicare advantage member. It's offered for free to those members, keeping them healthy. Just because you're 65 doesn't mean the light switch turns on and you wait until somebody gets sick. But even those who are stable chronic, a lot of our members, silver sneaker members who are in the Medicare advantage plans, many of them it's the first time that they've joined a gym. And as you get to be 65 and 70 you're accumulating chronic diseases and many of them have one or two chronic diseases, especially in the stable chronic, but there's a recognition by the health plans.

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Donato Tramuto: Keep them active, get them socially connected. Address not only their brain health, address the physical health and address the story health. And we even have members who are in that third category where they are beginning to recognize that you don't have to bench press 150 pounds, but keeping yourself active can help to reduce the overall cost of healthcare. And that's why Medicare advantage, it's been growing over the last number of years,

Bob Powell: About a third of all beneficiaries.

Donato Tramuto: And last year I have to tell you that I was very pleased with the chronic care act that was passed by the Congress and the Senate that now for the first time, if you are in a Medicare advantage plan, that the plan can design programs based on your chronic conditions. So let's say the majority of chronic conditions, as we know, are tied to obesity, plans can now offer a nutritional management program. Or if you're in rural America and you have a high hemoglobin A1c associated with diabetes and you're not getting enough food, there's food insecurity. Those plans can individualize and develop a program for that individual. Historically you couldn't do it. You had to offer the program to all seniors. So I really think the understanding of the social determinants of health, recognizing that where you live, where you sleep, your financial makeup, probably has more determinants in terms of your health outcome than your genetic code. And the Medicare advantage plans now have an opportunity to get that data and begin to develop programs that keep you healthy and not wait until you get sick.

Bob Powell: Any tips on selecting the Medicare advantage plan? There are obviously many out there. Any costs associated with them?

Donato Tramuto: You know I think today, listen, you know, I've watched this play out, you know, for the last 20 years since the modernization act, for Medicare was passed in 2003 and there was much more competitiveness among copay and network and premium. I think today those are all kind of table stakes. You know, I think if you look at any Medicare advantage plan, I think I would argue to say that the copay in the network and the premiums are probably the same. However, it's the shining objects. Look at a plan that offers physical fitness, like silver sneakers. It's the next layer of offerings that I would encourage members to be looking at and to be selecting plans that you know, keep you well, that understand the concerns about loneliness and social isolation, as well as addressing your nutritional needs. I would now look at those categories as the reason why I'm selecting a plan.

Bob Powell: Yeah. Anything else that we haven't touched on that you think would be important for people to know about these plans?

Donato Tramuto: I think the one that I just wanted to say I want to really think many of those Medicare advantage plans that have stepped up and are recognizing that offering physical fitness, which by the way is not just addressing physical fitness, you're addressing social fitness. And I have to really take my hats off to many of the leadership, leaders in those plans that recognize you're either going to pay, you know, at the front end or you're gonna pay at the backend. And you're gonna pay more at the back end. I'll leave you with one story. My Dad was a diabetic. 1987 he had his foot amputated and then had his entire leg amputated. And all the resources came in. They paid all the bills, but you know, no one during his years when he was a diabetic, went into his home and monitored his nutritional intake. No one encouraged him to work out. And had they done that, my dad would have had a much better quality of life than what happened after he had the amputation. And so there's a passion here for me, and that is to keep people healthy and have them enjoy those better years, which should be the golden years.

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