The annual open enrollment period for Medicare Advantage plans is now underway, presenting a crucial opportunity for beneficiaries to review their healthcare options.Health insurers are implementing meaningful changes to their plans for 2026, prompting individuals to assess if their current selections still align with their needs, particularly regarding comprehensive cancer treatment.
Patients have until December 7 to elect a new plan or modify their existing coverage. This period is especially critical for those receiving or planning to receive cancer care at Roswell Park Comprehensive Cancer Center. Carefully examining your coverage is paramount,and making adjustments before the deadline is essential.
Understanding Your Coverage at Roswell Park
Table of Contents
- 1. Understanding Your Coverage at Roswell Park
- 2. Navigating Plan Changes and Finding Alternatives
- 3. Independent Health Plan Update
- 4. Understanding Medicare Advantage Plans
- 5. Frequently Asked Questions About Medicare Advantage and Roswell Park
- 6. What steps should patients take if their insurance claim for cancer treatment is initially denied?
- 7. Ensuring Your Health Insurance Covers Essential Cancer Care: Insights from Roswell Park Complete Cancer Center
- 8. Understanding your Cancer Care Benefits
- 9. Decoding Common Insurance Terms related to Cancer Treatment
- 10. Roswell Park’s Approach to Insurance Navigation
- 11. Specific Cancer Treatments & Insurance Coverage
- 12. What to Do If Your Claim is Denied
- 13. Resources for additional Support
Confirming whether Roswell Park is within your plan’s network is the first step. This verification ensures uninterrupted access to specialized care and reduces potential out-of-pocket expenses. According to the Centers for Medicare & Medicaid Services (CMS), approximately 50% of Medicare beneficiaries are enrolled in Medicare Advantage plans as of 2024 , highlighting the importance of understanding network coverage.
Roswell Park patients with Medicare Advantage plans should instantly check their 2026 benefits. You can do so by contacting Roswell Park directly at 716-845-8760 or by visiting RoswellPark.org/Medicare. It’s vital to review plan documents and not rely solely on previous coverage details.
Securing a Medicare Advantage plan that includes Roswell Park in its network delivers peace of mind, guaranteeing continued access to trusted services and a dedicated cancer care team. While Roswell Park participates in numerous Medicare Advantage plans, individual coverage can vary.
Roswell Park offers resources to connect patients with Medicare experts capable of identifying plans tailored to their specific requirements and budget. A comprehensive list of specialists and in-network plans can be found on the Roswell Park website.
Independent Health Plan Update
Vital changes are affecting patients with Independent Health Medicare Advantage plans. Effective January 1, 2026, Roswell Park and its affiliated Roswell Park Care Network locations will no longer be in-network for Independent Health’s individual Medicare Advantage plans. Though, this change does not impact Independent Health commercial or group retiree plans.
patients enrolled in affected Independent Health plans are strongly encouraged to explore alternative coverage options before the December 7th deadline. Additional guidance and support are available at RoswellPark.org/Medicare.
| Insurance Provider | Impacted Plans | Action Required |
|---|---|---|
| Independent Health | Individual Medicare Advantage | Explore alternative coverage before December 7th |
| Other Medicare Advantage | All Plans | Verify roswell Park network status for 2026 |
| Commercial & Group Retiree | Independent Health plans | No action required. Coverage remains in-network |
Did You Know? Medicare Advantage plans frequently enough require referrals from primary care physicians to see specialists. Ensuring your plan permits direct access to Roswell Park specialists can streamline your care.
Pro Tip: Keep a record of your plan’s customer service number and member ID readily available when contacting your insurer.
Understanding Medicare Advantage Plans
Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare. They typically include benefits beyond Original Medicare (Parts A and B), such as vision, dental, and hearing coverage.However, these plans often come with network restrictions, requiring beneficiaries to utilize in-network providers to avoid higher costs.
Choosing the right Medicare Advantage plan requires careful consideration of your healthcare needs, preferred providers, and budget. Annual review is crucial as plan details can change significantly each year.Resources like the Medicare Plan Finder (https://www.medicare.gov/plan-compare/) can assist in comparing plans and identifying those that best suit your individual circumstances.
Frequently Asked Questions About Medicare Advantage and Roswell Park
- What is the open enrollment period for Medicare Advantage plans? The annual open enrollment period runs from October 15th to december 7th.
- How do I check if Roswell Park is in-network with my medicare Advantage plan? Contact Roswell Park at 716-845-8760 or visit RoswellPark.org/Medicare.
- What if my current plan no longer covers Roswell Park? Explore alternative Medicare Advantage plans that include Roswell Park in their network before December 7th.
- Does this impact all Independent Health plans? No, only Independent Health’s individual Medicare Advantage plans are affected.
- What resources are available to help me choose a new plan? Roswell Park connects patients with Medicare experts who can provide personalized guidance.
- Is there a cost to speak with a medicare expert? The cost may vary depending on the expert; Roswell Park provides a list of resources available to patients.
- what should I do if I am unsure about my coverage? Contact your Medicare Advantage plan directly and review your plan documents carefully.
Are you prepared to review your Medicare Advantage plan before the December 7th deadline? What questions do you have about ensuring uninterrupted cancer care at Roswell Park?
What steps should patients take if their insurance claim for cancer treatment is initially denied?
Ensuring Your Health Insurance Covers Essential Cancer Care: Insights from Roswell Park Complete Cancer Center
Understanding your Cancer Care Benefits
Navigating health insurance during a cancer diagnosis can be overwhelming. Knowing your coverage for cancer treatment, including chemotherapy, radiation therapy, surgery, immunotherapy, and supportive care, is crucial. Roswell Park Comprehensive Cancer Center emphasizes proactive understanding of your policy. Here’s a breakdown of key areas to focus on:
* Policy Type: HMO, PPO, EPO, and POS plans all have different rules regarding in-network and out-of-network care, referrals, and pre-authorization requirements.
* Deductibles, Co-pays, and Coinsurance: Understand how much you’ll pay out-of-pocket before your insurance begins to cover costs. Cancer treatment can quickly lead to meeting (or exceeding) your deductible.
* Out-of-Pocket Maximum: This is the most you’ll pay in a year for covered services. Knowing this limit provides financial peace of mind.
* Preventive Services: Many plans cover cancer screenings (mammograms, colonoscopies, Pap tests) at 100% when performed in-network.
Several terms frequently appear in insurance documentation.Clarifying these will empower you to advocate for your care:
* Pre-authorization (Prior Authorization): Many insurance companies require pre-approval for specific treatments, especially expensive ones like targeted therapy or clinical trials. Roswell Park’s financial navigation team assists patients with this process.
* Medical Necessity: Insurance companies typically only cover treatments deemed “medically necessary.” This means the treatment is appropriate and effective for your specific condition.
* In-Network vs.Out-of-Network: In-network providers have negotiated rates with your insurance company, resulting in lower out-of-pocket costs. Out-of-network care is generally more expensive.
* Clarification of Benefits (EOB): This document details the services billed, the amount your insurance paid, and your duty. Always review your EOBs carefully for errors.
Roswell Park Comprehensive Cancer Center provides dedicated financial navigation services to help patients understand and manage their insurance coverage. These services include:
* Benefits Verification: Roswell Park staff will verify your insurance benefits to determine your coverage for specific treatments.
* Pre-authorization assistance: They will assist with obtaining pre-authorization for necessary procedures and medications.
* Financial Counseling: Financial counselors can help you understand your out-of-pocket costs and explore financial assistance options.
* Appeals Support: If a claim is denied, Roswell Park can help you navigate the appeals process.
Specific Cancer Treatments & Insurance Coverage
Coverage varies depending on your plan, but here’s a general overview:
* Chemotherapy: Typically covered, but pre-authorization may be required. Coverage frequently enough depends on the stage and type of cancer.
* Radiation Therapy: Generally covered, with similar pre-authorization requirements as chemotherapy.
* Surgery: Usually covered when deemed medically necessary. Coverage for reconstructive surgery following cancer treatment is frequently enough mandated by law.
* Immunotherapy: Increasingly covered, but can be expensive. Pre-authorization is almost always required.
* targeted Therapy: Coverage can be complex and often requires pre-authorization.
* Clinical Trials: Coverage for clinical trials is improving, but can still be limited. Roswell Park actively works with insurance companies to secure coverage for eligible patients participating in trials.
* Genetic Testing: Coverage for genetic testing related to cancer risk and treatment is expanding, but varies substantially by plan.
What to Do If Your Claim is Denied
don’t panic. Claim denials are common. Here’s a step-by-step approach:
- Review Your EOB: Understand the reason for the denial.
- Contact Your Insurance company: Call the member services number on your insurance card to discuss the denial. Document the date, time, and name of the representative you spoke with.
- Gather Supporting Documentation: Collect any relevant medical records, letters from your doctor, and your insurance policy.
- File an Appeal: Follow your insurance company’s appeal process. Roswell Park’s financial navigation team can assist with this.
- Consider External Review: If your appeal is denied, you may have the right to an external review by an independent third party.
Resources for additional Support
* The National Cancer Institute (NCI): https://www.cancer.gov/
* The American Cancer Society (ACS): https://www.cancer.org/
* Cancer Financial Assistance Coalition (CFAC): https://www.cancerfac.org/
