Millions of Americans have chosen a Medicare Advantage plan over original Medicare for their health care needs. Navigating the terrain can be challenging, however.
Plan options are plentiful, and choosing the best option might feel overwhelming.
That’s why Sanford Health Plan is committed to empowering members and prospective members with the resources and education needed to feel confident in their health care coverage.
What is Medicare Advantage?
First, the basics: Medicare Advantage is a type of health plan offered by private insurers that contract with the federal government to provide members Medicare Parts A (inpatient) and B (outpatient).
Many Medicare Advantage plans, including Align powered by Sanford Health Plan, also include Part D (prescription drug) coverage and additional benefits like dental, vision and hearing.
Within the Sanford Health service area, there are about 35 Medicare Advantage plans to choose from. With so many options, it is important to know the differences among them.
Medicare Advantage plans typically offer lower out-of-pocket costs compared to original Medicare; they do not have enrollment rejections due to pre-existing conditions, and overall member satisfaction is generally higher.
However, there can be significant differences among Medicare Advantage plans.
“If you’ve seen one Medicare Advantage program, you’ve seen one Medicare Advantage program,” said John Snyder, president of Sanford Health Plan. “In other words, they’re all very different. The motivations and business goals for those providing the options can vary quite a bit depending on the plan you pick.”
How is Sanford Health Plan different?
The Medicare Advantage plans offered through Sanford Health Plan have some built-in differences. Unlike many other Medicare Advantage plans, for instance, this plan is backed by a network of Sanford Health providers who work together with the health plan to deliver personalized care.
This comprehensive, collaborative approach focuses on keeping people healthy and out of the hospital by providing members with innovative services to improve health and manage their chronic conditions.
Faster referrals, lower premiums
Medicare Advantage plans with strict prior authorization policies have been making headlines in recent months for denying members access to appropriate care.
“Prior authorization” is the process health insurance companies have in place for providers to request permission for their patients to receive certain services. The process can be time-consuming, leaving members uncertain if their care will be covered.
That’s not the case at Sanford Health Plan.
“Since we are part of an integrated system, we have a collaborative approach with our provider colleagues to ensure patients remain at the center,” Snyder said. “Many services do not require prior authorization. For those that do, the administrative elements are streamlined, eliminating much of the burden that can potentially slow down care.”
Other key differences for Align powered by Sanford Health Plan include:
- $0 plan premium options
- Low out-of-pocket maximums
- $0 primary care provider and specialist copays
- Integrated benefits that make seeking care easier such as reduced prior authorization requirements (direct access) and access to health navigators
- Included prescription drug coverage
- Supplemental benefits, specifically allowances for hearing, dental, and vision
How to choose a Medicare Advantage plan
Snyder strongly recommends that those comparing Medicare Advantage plans find out how each plan is rated with the Centers for Medicare and Medicaid Services. Align powered by Sanford Health Plan has a 4.5 star rating out of 5 stars in 2023.
“The CMS sets the bar very high,” Snyder said. “Our rating is one of the best out there. We’re the only plan rated that high in South Dakota and one of two in North Dakota.”
A big reason for the high rating for Align powered by Sanford Health Plan is its direct connection to clinical care. The provider and the health plan work together.
“We can combine our clinical data and our claims data and help predict how to better take care of you,” Snyder said. “There are a lot of advantages to being surrounded with an integrated system that is focused on you as a member.”
At Sanford Health Plan, the resources needed to make informed decisions are readily accessible. The folks who can help you are a phone call or email away.
“We have a team of individuals who are trained to help walk you through the process,” Snyder said. “It can be very complicated. You want to be sure you’re picking the plan that best meets your needs.”
About Align powered by Sanford Health Plan
Visit align.sanfordhealthplan.com or call (888) 605-9277 (TTY: 711) for help in understanding the different parts of Medicare or assistance with Medicare Advantage enrollment.
Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, or any other classification protected under the law.
If you need language services or information given in a different format please call (888) 278-6485 (TTY: (888) 279-1549). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (888) 278-6485 (TTY: (888) 279-1549). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電(888) 278-6485 (TTY: (888) 279-1549).
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Posted In Health Plan, Healthy Living, Senior Services
