It’s Medicare Open Season: Be Aware! Very Aware!

On October 15 it started. The annual six weeks of increasing daily robo calls and ubiquitous TV ads offering people 65 years old and over free (almost) hospital and medical care, doctor visits, dental, vision and hearing care plus gym time, cash cards and more. What’s going on? Is this for real?

What is happening is that Oct. 15 began open enrollment season for Medicare – the federal medical care insurance program. Oct. 15 – Dec. 7  is the only time (with some exceptions) all year that anyone on Medicare can switch plans. 

“Medicare is a really big deal,” said Brian Kaskie a journalist who has been covering Medicare for some 20 years. “It has literally changed the lives of American seniors from a majority facing potential poverty due to the medical expenses of aging, to now a majority having basic doctor, hospital and drug insurance coverage and the chance for a longer healthier life.” In fact, Medicare has become so successful that it has become the model for a universal health care system pushed by many Democrats and some Republicans. Medicare has become one of the biggest line items in the U.S. budget – currently comprising almost 15 percent. As it grows, the taxes needed to cover it will as well.

Most seniors view Medicare as their safety net to cover hospital, doctor and drug benefits. Most sign up as early as possible – three months before their 65th birthday – unless they are still working and have a better insurance plan. Those who don’t sign up when first eligible for Medicare, face lifetime penalties.

Medicare doesn’t cover everything however. Not all doctors accept Medicare payments so Medicare recipients may have to change doctors or pay their favored practitioner or surgeon out-of-pocket. Even the core Medicare Parts A (hospital) and B (doctor) plans, only cover 80 percent of the costs. So most Seniors choose between a plethora of “supplemental plans” offered by a wide range of providers in order to cover the 20 percent.

And Seniors must choose between dozens of plans to get the required Medicare Part D prescription drug benefit. The costs and coverage vary widely in these plans. Most use only certain drug stores.

Traditional Medicare has no dental, vision or hearing care options. At least up to now although there is much news from Congress of legislators trying to include them in various bills. This is one reason the new Medicare Advantage plans have sprung up provided by local health and medical networks. In the Washington D.C. area, Sigma and Kaiser are the two main Medicare Advantage providers. To attract buyers, the Medicare Advantage plans also include in-house Plan D drug benefits and limited dental, hearing and vision services and discounts as well as membership in certain gyms and other health benefits – all at designated providers.

Medicare Advantage plans can be the most inexpensive options to start off with, especially if the senior is healthy. But as the senior ages or needs serious medical care, the Advantage plans become more expensive, and the co-pays including for ambulances can be very costly. Seniors must be particularly aware of their own health, life style and financial conditions when choosing an Advantage plan. Regulations make it difficult to switch to the cheaper traditional Medicare plans later.

But there is more. Medicare provides some limited short term rehabilitation services. However, there are gaps sometimes referred to as doughnut holes in coverage that can be costly. So many seniors decide to buy extra insurance to cover temporary rehab benefits. In addition, emerging seniors are advised to invest as soon as they can in private long term care insurance plans with fixed premiums, that will cover intensive even palliative care either at home or in a long-term care facility.

Medicare benefits and options are increasing every year as the rules and regulations are constantly changing. As Medicare grows in coverage – even without the Democrats’ passing a multi-trillion dollar “social infrastructure” bill that will expand it even more. While almost all the advisers who are behind the robo calls are trying to sell a particular advantage plan, making an appointment at the Medicare office itself usually will give you a knowledgeable expert to guide you through the various options: traditional Medicare A and B plans, the various D plans, particularly the pros and cons of the many supplemental plans as well as the Medicare Advantage plans available in the area. They can also advise on short term rehab insurance and long term care plans.

There are a lot of reviews and decisions to be made between Oct. 15 and Dec. 7. With all the constant tweeks and changes as competition between providers increases, most seniors will find it will be an annual task, for better or for worse.

This story was supported by a Journalists in Aging Fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Silver Century Foundation.



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