Action Alert: Medicare Open Enrollment by Abby Block
The Medicare open enrollment or annual election period begins October 15 and ends December 7. You may be inclined to ignore it if you already have coverage, but consumer advocates urge eligible persons to use this opportunity to reevaluate their coverage options based on 2022 costs and benefits and their individual healthcare needs.
The choices include Original Medicare only, Original Medicare with Medigap coverage, or a Medicare Advantage plan. Original Medicare also offers optional prescription plans.
Under Original Medicare (Parts A and B),enrollees may use the services of any provider accepting Medicare covered patients. But Medicare generally only covers 80% of covered medical costs. Therefore, enrollees may choose to add Medigap plans or Medicare Supplement Plans. These plans, which are sold by private insurance companies, fill coverage gaps in Original Medicare to reduce out-of-pocket costs.The various Medigap plans vary in how much of the uncovered costs they pick up and the supplemental premiums vary accordingly, although there are some regulatory restraints on pricing. Enrollees can further reduce out of pocket costs by signing up for one of the Medicare prescription coverage plans (Part D). Those plans differ in what medications they cover, so enrollees should look carefully at plan coverage details.
Medicare Advantage (Part C) plans are offered by private insurers to cover healthcare servicessimilar to Original Medicare and Medigap but services are only available from providers within each plan’s network. Medicare Advantage planstypically also offer benefits not provided under Original Medicare such as dental and vision benefits. In addition, they may include prescription drug coverage.
During the open enrollment period, enrollees can switch from Original Medicare to Medicare Advantage, from Medicare Advantage to Original Medicare, from one Medicare Advantage plan to another, or from one Medicare prescription drug plan to another. They can also enroll in a prescription drug plan if they are not already enrolled in one.
Those switching back to Original Medicare will have the opportunity to enroll in a prescription drug plan and a Medigap plan during that process.
Leading into the open enrollment period, eligible people will be bombarded with information and advertising via TV, email, postal mail, the internet, and the phone. There will be endless offers of assistance from insurers, agents and brokers. While information from those sources may be useful, remember that this information is mostly coming from companies that want to sell you a product and have a financial interest in the outcome. The only official source is Medicare.gov.
If you wish to do some independent research beyond the government site, you can find information by Googling “Medicare versus Medicare Advantage” or other relevant topics. For example, a quick query for this article turned up a September 2021 article by Investopedia (https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp), and a short 2018 Kiplinger article (https://www.kiplinger.com/article/retirement/t039-c000-s004-medicare-vs-medicare-advantage-ill-health-switch.html). There was also a 2014 Consumer Reports article but this information may need updating (https://www.consumerreports.org/cro/news/2014/10/medigap-vs-medicare-advantage-consumer-reports/index.htm). When doing your research, be sure to consider the qualifications and potential biases of the sources.
The most current data shows that about one in five Medicare enrollees in Fairfax County are enrolled in a Medicare Advantage plan and that one in four Medicare enrollees nationally purchase Medigap coverage.
It is critically important to take the time to become an informed consumer and to understand both the benefits and costs under every option as well as the specific eligibility requirements. Those who do nothing will retain in 2022 whatever coverage they have in 2021, but that easy option may not be the best choice. By making the effort to do some research, individuals can increase the chances that they will have the right coverage for their specific circumstances going forward.