That’s because the “open enrollment” period has started (it ends Dec. 7), and different insurers want your Medicare business.
If you’re new to the game, however, you might ask, “Wait a minute —haven’t I already paid for Medicare through payroll deductions, and already sending part of my Social Security monthly payment to cover my Medicare policy?”
Yes, and yes. But Original Medicare falls far short of providing the kind of comprehensive coverage most people want and need.
A quick primer: Medicare has four parts: Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternate way to receive your Medicare benefits. And Part D provides prescription drug coverage.
Part C, where you can sign up for a Medicare Advantage, private health plan, is where many new recipients might get confused or find themselves unable to get the health care they want.
If you sign up for a Part C program, you still have Medicare and still have to pay your monthly Part B and your Part A premium (which, by the way, are going up in 2024 —Part B to $174.70/mo. in 2024, a $9.80 increase from this year). Each Advantage program is required to provide all A and B services, but are allowed to use different rules with different payments and restrictions.
But, if you don’t want an Advantage plan (usually HMOs), you can purchase a “Medigap” policy that can fill in many costly out-of-pocket expenses accrued from using Original Medicare, often from some of the same insurers selling Advantage programs.
Many seniors, however, aren’t aware they can sign up for Medigap policies only at certain times, and if they don’t jump then, might not be able to purchase them later. The best time to get a Medigap policy is when you first sign up for traditional Medicare, usually within a six-month period after age 65. If you sign up in that time frame, insurers can’t reject you or charge higher prices because of a prior or current health issue.
But if instead you sign up for a Medicare Advantage plan then you often have a limited network of doctors and hospitals available to you. Traveling out of network can also be a major issue. And if you choose a limited network, know that your favored doctors or hospitals can always leave it.
Consumer advocates also say that insurers often provide inaccurate information on in-network doctors on their websites. Before signing up for a supplemental plan, you shouldn’t just trust, but verify by calling doctors’ offices and hospitals that matter to you, and consider looking up other providers you might need unexpectedly. It’s also wise to call the insurer, and be specific about what plan you are researching and which doctors and hospitals you want.
Consumer advocates say for accurate, impartial information, start with Medicare’s website and look at various plans using the Medicare.gov tool.
Your prescription drug coverage can come through a stand-alone Part D plan if you are in traditional Medicare, or within your Medicare Advantage policy. Either way, you can use Medicare.gov to see if your prescriptions are included. This is worth doing every year.
Also, stay informed about the overall financial health of Medicare, which as of September, covered 65.1 million people. During fiscal 2022, Medicare accounted for $710 billion in federal spending, 11.4% of the $6.2 trillion total of spending. By 2028, the Medicare trust fund, which pays for hospitals, skilled nursing facilities and hospices, and is financed by payroll taxes, is expected to be exhausted.
President Biden in his 2024 budget has proposed changes that would keep Medicare solvent for 25 years through more drug price negotiations and raising a tax on the investment income of people who earn more than $400,000 a year. This places the entire burden of ensuring Medicare solvency on drug companies and high-income earners, but doesn’t deal with structural reforms that include containing costs for Medicare Advantage.
Remember all this as Congress spins into chaos, seemingly unwilling to take on difficult tasks such as ensuring the long-term viability and security of Medicare.
— The Santa Cruz Sentinel (Scotts Valley, Calif.)