Medicare Advantage and Your Care: A Letter from GVH CEO Jason Amrich

Dear Gunnison Valley Community,

I’m writing in response to a recent letter published in the Crested Butte News by Mike Rupp of Pitkin, where he shared his experience at Gunnison Valley Health (GVH) and the challenges he faced with his Medicare Advantage Plan. Reading Mike’s reflections on the care he received at GVH is one of the most gratifying aspects of my role as CEO. I’m incredibly grateful to work alongside a skilled and compassionate team of doctors, nurses, technicians, and support staff. It’s deeply rewarding to see how their efforts positively impact the lives of our community members every day.

Mike’s letter also raised an important issue—his experience navigating his Medicare Advantage plan. I’d like to expand on this, as it’s crucial for our community to understand the potential challenges of Medicare Advantage plans. While the decision is entirely yours, having all the facts can help you make the best choice.

Medicare Advantage plans, also known as Medicare Part C, offer an alternative way to receive Medicare benefits through private insurance companies instead of directly from the federal government. Some plans provide additional benefits, such as limited dental and vision coverage, but there are important factors to consider before choosing one.

Here are some key considerations about Medicare Advantage plans:

• Prior Approval Processes: These plans may require approval before you can receive treatments your doctor recommends, potentially delaying your care. Or they might refuse coverage for care that regular Medicare would cover
• Specialist Referrals: Often, Medicare Advantage plans require a referral from a primary care doctor to see a specialist, which can complicate timely access to the care you need.
• Network Adequacy (Limited Provider Access): Medicare Advantage plans typically have more restricted networks of doctors and hospitals, which could limit your ability to see preferred providers or those you've used for years.

At Gunnison Valley Health, we’ve seen these challenges firsthand. Many patients have faced delays or denials when seeking approval for necessary services, and in some cases, those denials may leave you responsible for the cost. Even when we appeal, we frequently encounter hurdles. In many instances, we believe that services might have been more easily approved under traditional Medicare. You can learn more from this recent news story.

As we approach the Medicare open enrollment period (October 15 - December 7), I encourage you to carefully review your options. While a Medicare Advantage plan may seem attractive at first glance, it could end up costing more or making it harder for you to access care. Taking the time to thoroughly review your coverage options and consider your anticipated healthcare needs is well worth the effort to ensure you choose the best plan for you.

Our goal in sharing this information is to help you make an informed decision and avoid unnecessary delays or denials in your care. Ultimately, each Medicare member must choose the coverage that best suits their needs. For unbiased advice, I encourage you to contact Joe Dix with the Colorado State Health Insurance Assistance Program at 970-765-3129, the Colorado Division of Insurance’s State Health Insurance Assistance Program at 1-888-696-7213 or visit the official Medicare website at www.medicare.gov.

As always, our commitment remains to the health and well-being of our patients and the entire Gunnison Valley community.

Sincerely,

Jason Amrich – CEO Gunnison Valley Health