Medicare open enrollment has started, and like many things in the insurance world, it can be very confusing.
Medicare open enrollment begins Oct. 15 and ends Dec. 7. This is the time to choose or change Medicare coverage for folks 65 and older. Medicare coverage has four parts: Part A, Part B, and Part D, also referred to as traditional Medicare; and Part C, also called Medicare Advantage.
“Traditional Medicare is essentially a one-time option at 65 to select,” said Dr. James Horn with St. Elizabeth. “If you opt into a Medicare Advantage plan because while possible, it’s very hard to go from Medicare Advantage back into traditional Medicare.”
Part A covers hospital stays, hospice care and some skilled nursing care. It is usually free (as long as you or your spouse has worked for 10 years), but there is a deductible for each hospital admission.
Part B covers doctor visits, outpatient care, medical equipment and some preventive services. It usually requires paying a monthly premium.
Part D provides prescription drug coverage. It can be selected during the Medicare Initial Enrollment Period or individuals can enroll during the Medicare Advantage Open Enrollment Period.
Part C or Medicare Advantage is an alternative to traditional Medicare that offers a bundled plan of Part A, Part B and usually Part D. These plans are run by private insurance companies and may offer additional benefits like dental, hearing and vision care, which are not covered under traditional Medicare.
Horn broke down the options. He said the option to opt into traditional Medicare – Parts A, B, and D – have been around since Medicare’s inception in 1965. Medicare Advantage plans, Horn said, are the government allowing to other insurers to operationalize and manage Medicare health plans. Examples of those other insurers include Humana, WellCare, Buckeye and Medical Mutual.
He said a Medicare Advantage plan can feel simpler because it includes Part A, B, and D instead of enrolling in all three separately; however, Horn said St. Elizabeth has run into issues with Medicare Advantage patients. He said those plans can be difficult to deal with, impacting the care delivered to patients. Horn said they have seen an increase in denials of care, increased out-of-pocket expenses to the patient and higher lengths of stay in the hospital.
“We understand that they (Medicare Advantage plans) seem very desirable at 65 when you’re younger, healthier, the options appear to be more attractive,” Horn said. “I think the challenge for us becomes, as those patients age and require inpatient hospitalization and more intensive health care, those plans may not be the best ones at that point in time. So, when people are making their decisions, understanding what to sign up for, they’re really not just thinking about today, but they’re really kind of looking over the next, potentially, 5, 10, 15 years down the road.”
Lauren Trondle with Senior Benefits Simplified said the cost of care varies depending on the type of plan enrolled in and the insurance company used.
Trondle said individuals usually pay a premium for Medicare Part B, which begins at $174.70 per month this year but fluctuates yearly. Part B premiums, copays, and deductibles depend on the individual plan and insurance company, but for someone on a Medicare supplement this year, Trondle said their deductible was $240. That number also changes year by year.
“The numbers are usually based on the cost of living and what Centers for Medicare and Medicaid have decided as the new appropriate amounts for the deductible and premiums based on Social Security increases,” Trondle said.
Those on a Medicare Advantage plan have copays for certain types of services. For instance, if someone sees their primary care physician, there is a $0 copay, whereas if they see a specialist, the copay could be between $30 and $40. Hospital stays are between $300 and $375 per day for a certain number of days, and then the plan kicks in.
When enrolling in or making changes to Medicare plans, remember that the coverage might be out of the network of your primary care doctor.
Horn said they have found that Medicare Advantage plans can be very geographic and, at times, more restrictive than traditional Medicare.
“What we would advise is that if people are looking to move or switch physicians or retain a physician, they really have to get back in contact with their plan to really understand what those options are available to them,” he said.
Another thing to consider when selecting the right Medicare plan is that traditional Medicare plans do not offer vision, dental, or hearing coverage, while Medicare Advantage plans do. Trondle said those extra services are built into Medicare Advantage because it is funded in part by Social Security.
Trondle said that people, throughout their working lives, rely on their companies to narrow their health insurance options. Each year, they receive an open enrollment packet, review the benefits with one insurance company, and choose from them. When it comes time to enroll in Medicare, it is up to the individual to look at the available plans and ensure they meet their needs.
Trondle said she always asks her clients what they are looking for regarding health insurance. Are your doctors in the network with the plan you’re looking at? Are the prescriptions that you’re taking in the plan? Do you need the additional benefits of dental, hearing and vision?
Those with questions about their plans should contact their insurance company, a local Medicare broker or visit Medicare.gov.
