Science

5 Costly Mistakes to Avoid in Medicare Open Enrollment

Millions of retirees are in the thick of Medicare Open Enrollment, which runs from October 15 to December 7, but many find the process challenging.

Some don’t understand the difference between Original Medicare and Medicare benefits; According to a July 2022 report from health care consulting firm Sage Growth Partners, many people are overwhelmed by Medicare advertising and only 4 in 10 people review their plan options each year.

This leads to Medicare open enrollment misses, not having to confirm that your provider is in network for the next plan year and not comparing your Medicare Part D prescription drug coverage with other available options.

Below are 5 of the most common Medicare open enrollment mistakes.

Not checking your doctors for 2023

If you have a Medicare Advantage plan, you generally must seek medical care from doctors within that plan’s network — and a plan’s network can change at any time. Before you decide to stick with that plan, make sure your preferred medical provider is still in the plan’s network in 2023.

This may require some legwork on your part, as websites and provider directories are not always up to date.

“I was just on a client, and[the plan]said they didn’t have a doctor-network, and it made us call the provider and see a different site on the network side,” said Evan Tunis, president of Florida Healthcare. Insurance. “The best thing I would recommend is to call the doctor’s office and just confirm with them.”


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Not Comparing Prescription Drug Plans

Whether you have Original Medicare or Medicare Benefits, your prescription drug coverage comes from a private insurance company, and it may change what it covers each year. Your regular prescription drug could cost more in 2023, or an insurer may not cover it at all. (Another plan may also cover it for less.)

It pays to plug your drugs into Medicare. Check to see what plans they recommend for you. Pro tip: If you log into your account on Medicare.gov, you already have your medication history.

“It makes it a lot easier for them to shop for the next year,” said Katy Votva. “They don’t have to put everything in line by milligram and line by milligram.”

Thinking that all doctors will take your PPO plan

A preferred provider organization, or PPO, plan, is a health plan that allows members to see out-of-network doctors, usually for a higher price. People sometimes think that because they have a Medicare Advantage PPO, they will be able to see any doctor they want. But providers don’t always take out-of-network coverage.

“Providers … can refuse someone at the point of service if they don’t want to bill the plan,” Tunis said.

Case in point: Mayo Clinic in Florida is out-of-network with most Medicare Advantage plans and will not schedule appointments for members with out-of-network Medicare Advantage coverage.

For the full provider option, choosing Original Medicare with Medicare Supplement Insurance, or Medigap, “is the prudent solution,” Tunis said.


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splash ads

The Medicare open enrollment season has meant that Medicare commercials, and Medicare Advantage plans, have done tempting things to offer no premiums and some coverage for hearing, dental, and vision care.

But shopping for your health coverage has more than a side benefit. “Most of the time, honestly… they don’t cover that dent,” Votava said. “Hearing aid coverage is also very limited, and that’s not a reason to change your plan, so be very careful.”

More important, Votva said, is making sure the plan covers your doctors and prescriptions for the next year.

Waiting too long to start my research

Medicare Open Enrollment ends on December 7, but you don’t want to wait until the last day — or last week — to start your research. If you have questions, you can get help through programs such as the State Health Insurance Assistance Program, or shipwreck. Counselors on ship programs can provide free help with your Medicare options, but they tend to be busy.

Ship schedules in some parts of the country have been booking for several weeks. “If you need help, don’t wait,” Votava said.

You can find your local ship at Shiphelp.org.

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