How to Enroll in Medicare Plans for 2024: Answers to Your Questions
Nov 29, 2023
Whether you should
choose traditional or Advantage—and other tips
Medicare’s open-enrollment period is under way, and you have
questions.
Patient
advocates say they are swamped with calls from seniors struggling to decide on
their coverage for next year, which they have to choose between now and Dec. 7.
Many beneficiaries are overwhelmed by the deluge of marketing pitches flooding
their TVs, mailboxes, computers and phones.
Even Wall Street Journal readers, a
sophisticated bunch, wrote in with queries in response to a recent story about
Medicare pitfalls.
Here are some of the most common
questions, according to counselors who work with Medicare beneficiaries, along with
some answers and resources to help you learn more.
Medicare Advantage or
original Medicare?
This is the biggest question for
most beneficiaries, and Journal readers debated it in comments and emails. Do
you sign up for the traditional government program or one of the widely
promoted Medicare Advantage plans that provide coverage through private
insurers?
If you need a primer on the basic
differences, look here or here.
The answer depends on your
situation and priorities, say patient counselors. Medicare Advantage plans can
offer appealing extra benefits such as dental coverage and gym memberships. Yet
they might also limit your choice of doctors and force you to jump through
hoops to get care, as this
Journal story noted. That is particularly likely with HMOs, or health
maintenance organizations.
“It might be a zero premium, but if
you have to travel 50 miles to see a provider once a week, you’re not saving
money,” says Christina Dimas-Kahn, deputy director of the nonprofit California
Health Advocates.
Original Medicare might be better
if you want freedom to choose your care and where you get it. Still, you will
almost certainly need a Medigap policy, or Medicare supplement, a special type
of coverage that helps with the out-of-pocket costs of traditional Medicare
that otherwise aren’t capped. But be warned: If you don’t buy a Medigap policy
right after you join Medicare as a senior, you might not be able to get one.
Check the rules here.
What can I do to save
money?
Advocates say many Medicare
beneficiaries are closely focused on their costs. For starters, check whether
you are eligible for special financial help for those with limited incomes.
Many seniors qualify but fail to sign up, says Kelli Jo Greiner, director of
the Minnesota State Health Insurance Assistance Program.
If they do, she says, “people can
save a substantial amount of money.”
To learn about the federal aid
program for drug-plan expenses, sometimes called “extra help,” go here or
call 1-800-772-1213. States administer the separate Medicare Savings Program,
which can help with the costs of your medical coverage and care. You can ask
your State Health Insurance Assistance Program, or SHIP, for help applying here.
In choosing coverage, you need to
look carefully at your likely expenses. Every year, you should check your
prescriptions in different plans, using the federal tool at Medicare.gov.
If you opt for a Medigap policy,
you’ll pay a set premium each month, which can be significant, but you should
have limited out-of-pocket liability if you do need care. See the different
Medigap options here.
Medicare Advantage plans often come
with a tempting feature—no monthly premium. They might also include substantial
out-of-pocket costs if you have medical needs.
“With original Medicare and a
supplement, you can figure out exactly what you’re going to pay,” says Linda
Castiglione, a retired lawyer who volunteers as a counselor for Medicare
beneficiaries through Connecticut’s SHIP. “With an Advantage plan, it’s pay as
you go.”
Yet some beneficiaries can’t afford
Medigap premiums, or have few health needs and don’t feel the monthly charge
for Medigap is worthwhile. For them, Medicare Advantage plans might be
appealing.
Do I get dental with
that?
A common sales pitch for Medicare
Advantage plans focuses on the extra benefits not covered through traditional
Medicare. These have proliferated in recent years, and they can include dental,
vision, hearing aids, over-the-counter drugs, fitness programs, groceries and
transportation to medical appointments—seemingly everything short of a
government-funded pony.
Advocates say beneficiaries should
research these extras closely. They might be very limited, or only available
under narrow circumstances.
The plan documents are likely your
most comprehensive source. To find those, you can go to the website of a
Medicare Advantage insurer, such as UnitedHealthcare of Humana. Once you find the
plan you want to examine, you should see a link with a label such as “plan
documents” or “enrollment materials.” Click that, then look for the “summary of
benefits” and the longer version called the “evidence of coverage.”
Those documents should explain everything about the
plan: the extra benefits and essential facts about the core medical
coverage—for instance, when you need a referral to see a specialist or
pre-approval for a medical procedure and what your out-of-pocket charges will
be for various services.
“You really need to spend some
quality time with the information,” says Sarah Murdoch, director of client
services at the Medicare Rights Center, a nonprofit. On dental, for instance,
does the plan cover “two cleanings and an X-ray, or is it more extensive?”
Can I change my mind?
Journal readers raised concerns
about buyer’s remorse, especially among older relatives who might have
inadvertently agreed to a coverage change after a phone chat with a
salesperson.
“They’ll get enrolled in something new and they don’t realize it,”
says Edward Clark, chair of the National SHIP Steering Committee, who says
advisers regularly get panicked calls from beneficiaries and family members.
You can change your decision up until the end of the open
enrollment period on Dec. 7. After that, if you picked a Medicare Advantage
plan, you can switch it between Jan. 1 and March 31. There are also some other
opportunities, and the rules are here,
but always keep in mind the limits on Medigap access.
Where can I learn more?
You
should probably turn to people who aren’t trying to sell you something.
Medicare Advantage companies and many brokers who handle their products have a
big financial stake in signing you up. Try Medicare.gov or 1-800-MEDICARE or
reach out to your state’s SHIP program
to start. The nonprofit Medicare Rights Center maintains a national helpline.
Healthcare advocates and local agents
with whom you have a relationship can also be helpful. Remember to take notes
and make printouts of materials.
Source: Wall Street Journal