This article is reprinted by permission from NextAvenue.org.
If the volley of flyers, brochures, letters, emails, social media ads and other marketing materials unleashed by insurance companies during Medicare open enrollment last fall had you feeling under siege, you’re not alone.
“I am a college graduate, but I do not understand any of it,” says Liz Markowski, 74, of Vergennes, Vermont, a retired nurse and small-business owner. “Frankly, I don’t want to understand it. I just want to be able to go to my doctor when I need to.”
Confusion is rampant. Complaints about deceptive marketing aimed at enticing Medicare-eligible consumers to join or switch plans more than doubled between 2020 and 2021, according to a report released in December by Democrats on the Senate Finance Committee.
The avalanche of competing plans is especially challenging for people experiencing cognitive decline, Harvard Medical School professors warn in a recent health policy article.
A bill introduced in Congress in the fall of 2022 would attempt to ease some of the bewilderment by prohibiting private insurers from using the term “Medicare” in plan names or marketing materials, with fines for those who fail to comply.
But the marketplace is likely to remain baffling. Private insurers offer some 3,000 Medicare Advantage plans nationwide, along with myriad Medigap, Part D, vision and dental policies.
Making sense of Medicare
So, it makes sense to take steps now to ensure a productive open enrollment journey in 2023. Here’s what experts and experienced Medicare consumers recommend adding to your list of New Year’s resolutions:
Know your plan
Only 6% to 12% of consumers switch plans during Medicare open enrollment, according to a study released in November by the Kaiser Family Foundation covering the years 2008 to 2020.
Some people stay put because they are happy with their current plans and find nothing better when they shop around. But others may be frozen in place by the immensity of choices, says Senior Policy Analyst Jeannie Fuglesten Biniek, lead author of the study.
Begin with the basics
If you’re in the confused camp, make time early in the year to nail down the basics:
- Are you in original Medicare or a privatized Medicare Advantage plan?
- Do you understand the pros and cons of each?
- If you have original Medicare, do you also have a supplemental private Medigap plan, Part D policy or both? If you get retiree health benefits through a past employer, it may be especially hard to tell.
“A lot of people don’t know what they have,” says Chuck Bradley, 76, a retired human resources executive from Watertown, Connecticut, whose friends often turn to him for advice about health insurance. “It is confusing.”
Challenge dodgy practices
Hold your 2022 plan accountable. If you are among the half of all Medicare-eligible consumers enrolled in a Medicare Advantage plan, make sure you’re getting what you were promised. If you discover otherwise, you may be able to change your plan by calling 1-800-MEDICARE.
And be sure to report deceptive marketing or billing to your local Senior Medicare Patrol, a program of the federal Administration for Community Living.
Regulators listen: CIGNA and United Healthcare, two of the largest providers of Medicare Advantage plans, are defending themselves in civil lawsuits brought or joined by the Justice Department in 2022. The suits allege the companies cheated the government out of hundreds of millions of dollars by claiming enrollees were sicker than they were. The insurers face fines of at least three times the amount they may have bilked taxpayers.
Track your spending
Understand your healthcare needs and expenses. January is a good time to review what healthcare services you used in the prior year and how much you spent. It’s also a good time to begin tracking expenses moving forward, if you don’t already.
“Print out the year’s expenses from your bank account, get a highlighter, highlight everything that was medical-related and add it up,” suggests Linda Matthew, a personal financial coach in New York City. “It doesn’t have to be complicated. You don’t need an app. You don’t need a spread sheet.”
Matthew recommends aiming for at least three years of data to guide you in comparing health insurance options during open enrollment. Ideally, that means beginning to track before you’re 62. Include copays, deductibles and other out-of-pocket expenses for medications and other health needs in your tallies.
Biniek further advises keeping track of how many times you visit doctors, who those doctors are and which prescriptions you filled.
That way, when open enrollment begins in 2023, you will be ready to compare costs and verify that a particular plan will cover your specific doctors, specialists and medications.
Talk to an expert. Bradley, the retired human resources executive, consulted with an insurance broker in the 2022 open enrollment period. He wanted to see if any of the heavily advertised Medicare Advantage plans could give him better coverage than his current plan: original Medicare with a Medigap policy through AARP. He concluded that he didn’t need the extra benefits Medicare Advantage plans offer, like dental insurance and gym memberships. He stayed where he was.
Free advice is available
“It’s become so complicated,” Bradley says. “I recommend that people go and talk to someone who is very familiar with all of the plans, who represents all of them.”
Biniek concurs. In addition to insurance brokers, she cites federally funded State Health Insurance Assistance Program (SHIP) counselors as a good option for free expert assistance. Each state has a SHIP office. Consumers can make an appointment for a consultation with a SHIP counselor during open enrollment each year.
Matthew, the financial coach, is an MIT-trained engineer. But she doesn’t try to navigate health insurance on her own. When her husband turned 65, a broker helped him choose a plan that meets his needs: original Medicare with a Medigap policy.
“Our broker is a lifesaver,” Matthew says. “She has all the information at her fingertips, so I don’t have to do the research. I’m supposed to be good at this stuff, but honestly, who has the 12 hours it would take?”
Claudia Mitchell Morain is a freelance writer and editor based in Davis, California.
This article is reprinted by permission from NextAvenue.org, ©2023 Twin Cities Public Television, Inc. All rights reserved.
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