Back when Medicare open enrollment began in mid-October, we promised you a series of helpful articles here on the AgingOptions Blog designed to help guide you through the maze of options so you could choose the plan that’s best for you. But now a glance at the calendar tells you that open enrollment is ending very soon. There are just a few days between now and December 7 th.
But don’t get discouraged and give up the quest – there’s still time to evaluate your options, starting with an honest assessment of the plan that you have. Since a high percentage of Medicare enrollees do nothing during open enrollment, you’ll be ahead of the pack if you take some time to evaluate your current plan, and avoid unpleasant surprises come January 1 st. To help you in that process, we present the final article in our 2022 open enrollment series: this timely piece from MarketWatch in which reporter Kate Ashford gives us her prescription on how to avoid five of the most common open enrollment mistakes. We think her article is a good place to start.
Open Enrollment Can be Challenging, Overwhelming
“Millions of retirees are in the thick of Medicare open enrollment,” Ashford writes, “which runs from October 15 to December 7.” But, she adds, for many the process can seem daunting. “Some don’t understand the difference between Original Medicare and Medicare Advantage,” she adds, while “many are overwhelmed by Medicare advertising.” All that may be part of the reason why, in Ashford’s words, “[only] 4 in 10 people review their plan options each year, according to a July 2022 report from health care consulting firm Sage Growth Partners.”
This sense of paralysis leads to what the MarketWatch article calls “Medicare open enrollment misses.” Here, according to Ashford, are some of the most common Medicare open enrollment mistakes. Remember, even though the days are flying by, there’s still time left in open enrollment to make the right choice, if you start right now.
Mistake #1: Assuming Your Doctor is Covered by Your Current Plan for 2023
Ashford’s first mistake applies chiefly to Medicare Advantage beneficiaries, a group that now comprises nearly half of all those covered by Medicare. “If you have a Medicare Advantage plan, you generally must get medical care from doctors within that plan’s network — and a plan’s network can change at any time,” Ashford warns. “Before you decide to stick with the plan you’re in, make sure your preferred medical providers are still in the plan’s network in 2023.”
Case in point: as this article was about to be posted on the AgingOptions Blog, a major fight between a major Seattle-area insurance carrier, Regence, and two prominent area clinics had just boiled over. As a result, 19,000 patients could be forced to change doctors. You can read the Seattle Times story here.
Unfortunately, MarketWatch acknowledges, checking on this important detail isn’t as easy as it sounds. “This may require some legwork on your part,” says Ashford, “since websites and provider directories aren’t always up to date.” As one Medicare insurance executive from Florida told Ashford, “The best thing I would advise is to call the doctor’s office and just confirm with them.”
Mistake #2: Not Comparing Prescription Drug Plans
The second potential error involves your prescriptions. “Whether you have Original Medicare or Medicare Advantage , your prescription drug coverage comes from a private insurance company,” says the article, “and it may change what it covers each year. Your regular prescription medication may cost more in 2023, or an insurer may not cover it at all.”
For this reason – and because prices vary between plans – you should take the time to plug your drugs into Medicare.gov to see what plans they suggest for you. As Ashford point out, “If you log into your account at Medicare.gov, your medication history is already there.” This is a big timesaver when comparing plans from year to year.
Mistake #3: Assuming All Doctors Will Take Your PPO Plan
The third potential pitfall concerns out-of-network coverage. “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,” says the MarketWatch article. “People sometimes think that because they have a Medicare Advantage PPO, they’ll be able to see any doctor they want. But providers don’t always take out-of-network coverage.”
Providers have the right to refuse out-of-network coverage if they don’t want to bill the plan, the article explains. As an example, Ashford cites the Mayo Clinic in Florida which “is out-of-network with most Medicare Advantage plans and won’t schedule appointments for members with out-of-network Medicare Advantage coverage.”
If full provider coverage is important to you, especially if you travel or live in multiple locations during the year, most experts agree that you’re better choosing Original Medicare with a Medicare Supplement Insurance plan , commonly called Medigap.
Mistake #4: Being Swayed by the Splashy Ads
We’ve written several times about the barrage of ads targeting seniors during open enrollment – mostly for Medicare Advantage plans. “Medicare open enrollment season means Medicare commercials galore,” Ashford writes, “and Medicare Advantage plans have appealing things to offer like no premiums and some coverage for hearing, dental and vision care.” These extras can be meaningful, but in some cases they may not provide as much coverage as you think.
“Most of the time, honestly…[these Medicare Advantage plans] don’t cover that much dental,” one expert told Ashford. “Hearing aid coverage is also very limited, and that’s not the reason to change your plan, so be very careful.” Instead of letting marketing persuade you, just make certain the plan you choose covers doctors you want and prescriptions you need, at the right price.
Mistake #5: Procrastinating too Long Before Asking for Help
As we noted above, the clock is ticking. “Medicare open enrollment ends December 7,” says Ashford, “but you don’t want to wait until the last day…to start your research. If you have questions, you can get help through programs like the State Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can offer free assistance with your Medicare choices, but they get busy.”
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(originally reported at www.marketwatch.com)