Science

Medicare Open Enrollment is about to close. Here’s what to know.

Seniors have one more day to make changes to their Medicare plans, including choosing a new Medicare Advantage plan, with open enrollment for the program closing at the end of December 7.

Medicare Advantage plans are becoming increasingly popular among seniors, with nearly half of Medicare-eligible Americans opting for one of these private programs this year, according to the Kaiser Family Foundation. Typical enrollment has 39 different plans to choose from, which means choosing the right plan can be almost overwhelming.

During open enrollment, seniors can also return to original Medicare plans, also known as Medicare Part A and Part B, and choose a new Medicare prescription drug plan or Part D. By comparison, Medicare Advantage plans typically bundle Part A, Part B. and Part D in the same plan, and often dangle other coverage, such as dental or vision, to persuade seniors to sign up.

Here are some pitfalls to watch for when choosing a Medicare Advantage plan that works for you, according to experts.

Investigate the providers of your Medicare Advantage plan

One thing seniors should do each year is to check that their doctors — and prescriptions — are within their Medicare Advantage plan’s coverage network. Unlike traditional Medicare, Medicare Advantage works like a private insurance plan, with in-network and out-of-network coverage.

Even if you’re in a Medicare Advantage plan that you want to keep, be sure to double-check your current plan’s providers because plans often change from year to year, says Medicare and Social Security policy analyst for seniors Mary Johnson. said the league.

“These are private insurers. They renegotiate their contracts with their providers every year, so providers can change — including pharmacies and prescription drug coverage,” she said. “It would be very unrealistic to think that you can just sign up and go on autopilot, but that’s what the majority of the public do.”

Often the quickest way to check is to call your provider’s office, as online directories sometimes aren’t up-to-date — and agents trying to sell you policies may give incorrect information. “The best thing I would recommend is to call the doctor’s office and confirm with them,” Evan Tunis, president of Florida Healthcare Insurance, told NerdWallet.

Check Your Plan’s Drug Coverage

Drug coverage is another important factor that can change from year to year within Medicare Advantage plans, so seniors should verify what they’ll pay for their prescriptions by visiting Medicare.gov, Johnson said.

Seniors who take insulin should double-check that the brand of drug they take is covered by their Advantage plan. Starting next year, the price of insulin will be capped at $35 a month — but this price cap only applies to brands that are covered under a plan’s coverage.

“If the brand you take is Lantus, and they cover some other insulin, it could potentially be that you get a mismatch,” Johnson said.

Seniors can check coverage by entering their drug information at medicare.gov.


How Drug Pricing Reform Will Work in the Inflation Reduction Act

01:38

View your out-of-network costs

One error Johnson often sees is seniors choosing an Advantage plan based on low premiums or freebies, such as a grocery allowance.

“Nothing in life is free,” said Johnson. “There are many Medicare Advantage plans that have very low premiums or even no premiums; however, there is a co-pay for almost every service people use.”

Johnson recommends projecting a worst-case scenario: If you become very ill and require an intensive medical procedure and multiple follow-up visits, what’s the maximum you can expect to pay out of pocket? For 2023, it could be as high as $8,300 if you go out of network.

On the other hand, many Medicare Advantage plans include vision and dental benefits that traditional Medicare doesn’t cover, so seniors need to weigh which factors are most important to them.

While a plan without premiums can save money for a healthy person, you can’t always predict when you’ll get sick and need a lot of care.

“Older people get sick and use services, so it’s a gamble,” Tricia Newman, director of the program on Medicare policy at the Kaiser Family Foundation, told NerdWallet.


New research: 100 million Americans face health care debt

02:29

take your time and be skeptical

During the current open enrollment period, which opened on October 15 and ends on December 7, seniors can switch from traditional Medicare to Medicare Advantage, or change Medicare Advantage plans. They can also go back to Original Medicare.

This isn’t the only chance to make changes for seniors already enrolled in Medicare Advantage. Those already in these plans can also change their Advantage plan between January 1 and March 31, though they can change plans only once during that time period.

But experts caution seniors against participating in a Medicare Advantage plan with the hopes of saving money or getting freebies like gym memberships. First, deceptive marketing abounds—from insurance agents falsely describing coverage and celebrity-filled TV commercials to marketing mailers disguised as “official” government mail.

“Seniors are being inundated with aggressive marketing tactics as well as false and misleading information,” Sen. Ron Wyden’s office concluded in a report last month.

Consider Medigap Coverage

It’s possible to switch back to traditional Medicare from Medicare Advantage during open enrollment, but seniors should also consider their Medigap coverage — formally known as Medicare Supplement Insurance. Seniors are first eligible for Medigap coverage when they turn 65 and enroll in Medicare Part B, which covers doctor visits and outpatient care.

During the six-month open enrollment period when they first sign up for a Medigap plan, seniors can buy any policy regardless of their health – but it’s only once. Seniors who sign up for an Advantage plan then go back to traditional Medicare may find themselves paying more for a Medigap plan — if they’re offered one.

“In most states, insurers are not required to offer Medicare and Medigap Supplements from your initial coverage period, when you first enroll in Medicare,” Johnson said.

The process can be confusing and overwhelming. “It’s a real pain for the average person. You probably feel as frustrated with the process as doing your taxes,” Johnson said.

People who need help can turn to one of two resources:

The State Health Insurance Assistance Program, or SHIP, can match seniors with a navigator trained in Medicare who can go over patient needs and recommend plans. Older people should also go through the Benefits Checkup run by the National Council on Aging to see if they qualify for programs that help pay for medicine, food and other needs.

Related Articles

Leave a Reply

Your email address will not be published. Required fields are marked *

Back to top button