Deadline for Medicare Open Enrollment is coming up. What you need to know to make it easy
Medora Lee, USA TODAY
Updated 5 min read
Medicare's annual open enrollment season is here through Dec. 7, but with a record 4,000 health care options available to seniors, choosing the right one can feel overwhelming.
Nearly three-quarters (72%) of 1,260 adults in a survey by insurance company Nationwide said they wish they understood Medicare coverage better. More than 70% couldn't correctly answer basic questions about Medicare, such as what it covers, how Medicare Part B works, and cost considerations for different Medicare plans. They also sharply underestimated the average cost of health care in retirement, putting it at $55,343 when the actual cost last year was almost triple that at $172,500 for an individual, it said.
With so much at stake, a recent survey by financial services firm Voya still showed that 7 out of 10 people would rather go to the dentist, get their car serviced, or prepare their taxes.
To help the more than 65 million Americans on Medicare weigh their options and decide whether to change or keep their current plans, experts offer advice to get you on the right path. First, know the difference between Medicare and Medicare Advantage, experts say. That’s explained below, followed by their top tips to ensure you have the best plan to suit your budget and your health needs.
Original, or traditional, Medicare gives you access to any doctor or hospital that takes Medicare in the U.S. and usually doesn’t require a referral to see a specialist. It’s composed of three parts:
◾ Medicare Part A is included and covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
◾ Medicare Part B is included and covers certain doctors' services, outpatient care, medical supplies, and preventive services. In 2024, the standard monthly premium for Medicare Part B enrollees will be $174.70, with an annual deductible of $240.
◾ Medicare Part D is an optional, separate prescription drug plan that you must choose and pay for as soon as you start receiving Medicare. If you wait, you may have to pay more.
Aside from those, you also have the option to buy supplemental coverage (also called Medigap) from a private insurer within six months of having Medicare Part B if you’re 65 or older. This coverage helps pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance). The supplement is a one-time enrollment, and if you don’t buy it within this window, you may not be able to add it later, or you'll have to pay more for it.
What is Medicare Advantage?
Medicare Advantage, also known as Part C, is a “bundled” plan that includes Part A, Part B, and usually Part D, and is administered by private insurers. Enrollees must pay the monthly Part B premium plus any plan premium.
You may have lower out-of-pocket costs and receive eye, dental, hearing, gym services but you must see doctors within the plan’s network, may have to get referrals for specialists that can delay your care, and pay more for out-of-network services.
What should I consider during Medicare open enrollment?
Drugs. As one of the top expenses for seniors, “medication dictates plan and doctors – everything,” said benefits and financial adviser Wilson Coffman, president of Coffman Retirement Group. To get this right, create a profile at Medicare.gov and enter the drugs and pharmacies you use to compare prices. Since companies constantly change drug coverage, this step is crucial every year to save money, he said. Companies even make changes during the coverage year so open any mail you receive from them. By law, they must send you three notices of the change, he said.
Doctors. If you’re enrolled in Medicare Advantage, you must check every year that your doctors are in network. They get paid less for Medicare patients and sometimes drop out, Coffman said.
Costs. Everyone must pay the monthly Medicare Part B premium, whether you’re on traditional Medicare or Medicare Advantage. Traditional Medicare allows you to pay extra for a Part D drug plan and Medigap Plan G that covers certain expenses such as coinsurance, copayments and deductibles that aren't covered under Medicare Part A and Part B. If you get the supplements, original Medicare premiums can easily outpace those of the Medicare Advantage plan premiums. However, some of those initial savings can evaporate quickly with a lot of out-of-pocket costs if you need any serious medical care, Coffman warns.
Chapters Health System offers occupational, physical and speech therapies as part of hospice and home care.
If you have a Medicare Advantage plan, you'll have one last chance to switch plans from Jan. 1 through March 31 during the Medicare Advantage open enrollment period.
Some financial advisers also provide free talks to help people separate the wheat from the chaff. Tim Davis, wealth manager at Davis Executive Wealth Management Group in Boston, said he hosts free webinars, for example, with time for questions.
After choosing your Medicare plan, Davis said you should take another step while you’re focused on health care and look at long-term plans. Medicare only pays for short-term acute care, typically for injuries, illnesses, urgent and emergency needs, and for recovery or rehabilitation after surgery. But most people will need some sort of long-term plan.
Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and support in their remaining years, according to the government agency Administration for Community Living.
Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at mjlee@usatoday.com and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday.
