Medicare recipients have some big decisions coming up for Medicare Re-enrollment (Oct. 15-Dec. 7). That’s when you must decide if you are staying with your current Medicare provider or switching to another insurer. It’s also when you can switch from Original Medicare to a Medicare Advantage Plan, or vice versa.
Philip Moeller is one of the nation’s most pre-eminent experts on Medicare and Social Security. He is the author of “Get What’s Yours For Medicare,” and “Get What’s Yours for Social Security. A new and revised version “Get What’s Yours for Medicare” is out Oct. 8.
Moeller sat down with Senior Planet for a wide-ranging interview of Medicare and Medicare Advantage, and advice for seniors about to sign up. The answers have been edited for clarity.
Question: What are some of the common mistakes people make when they sign up for Medicare.
Answer: The big challenge is for people who are aging into Medicare, they’re turning 65 and they’ve either retired from work or they’re about to retire from work. This transition means that they’re going to no longer have employer health coverage. This has several implications – probably the most practical one is that much of the complexity of the health care system was hidden by employer health plans because they do most of the heavy lifting for you. The employee doesn’t have a broad choice of the kinds of health coverage they get. People therefore aren’t really used to making the kind of decisions that they have to make when they enroll in Medicare.
This idea of whether you go into Original Medicare, or Medicare Advantage is brand new to people, and it’s a learning curve that can be pretty steep and trips up a lot of people.
Question: The late-night commercials for Medicare Advantage Plans are seemingly relentless. Explain the difference between Original Medicare and Medicare Advantage Plans.
Answer: There are two traditional pathways into Medicare.
Original Medicare covers part A for hospitals, Part B for outpatient expenses and doctors. And you can get a Part D, standalone drug plan. Many people with Original Medicare also get a Medigap supplement plan, because while Original Medicare has pretty extensive coverage, the biggest hole in is that it only pays only 80% of Part B expenses. Many people, especially those of some financial means, tend to favor a Medigap plan that helps close those gaps. The key thing here is you get to see any Medicare participating doctor you wish, and you rarely need prior approval for care.
The second approach into Medicare is a private Medicare Advantage plan sold by a private company. It covers part A, part B. You can also get a wrapped in Part D drug plan and dental coverage, which is not offered in Original Medicare.
With Medicare Advantage, you usually are restricted to see doctors in the network of care providers set up by the plan. The second thing is prior authorization is required for some tests or procedures. This process has been a real headache for everybody (both doctors and patients).
Question: Both options offer dozens of options. Medicare Part A is standard in Original Medicare, but there are literally dozens of options to pick for your Plan B and Plan D coverage. And there are dozens of different Medicare Advantage Plans. Where can I turn to for help in narrowing down the selection process?
Answer: Brokers can be really useful to you. Insurance Brokers know a lot, but they don’t necessarily represent the entire universe of products that you can choose from. By all means, talk to a broker, but do not make your purchase decision until you’ve taken what the broker has said, and tested it against the products that are available for you to buy.
Online Help
And you can do this pretty easily.
Medicare has online tools which are normally under a headline like Plan Finder. You can look at every Medicare Advantage plan offered where you live. You can look at every Part D drug plan offered where you live. So, take what your broker says, but then go to Plan Finder and see if, in fact, the plans that the broker recommends are the best ones for you in terms of cost, co-pays, things like that.
Medicare First-Timers
Question: Explain the enrollment windows for people signing up for Medicare for the first time.
Answer: The enrollment windows are designed to be easy for you, but I think they mislead people. For example, if you are 65 and enroll in Medicare, you have a seven-month enrollment window. It includes the three months before you turn 65, your birthday month, and three months after. It causes people to assume there’s no hurry. I can sign up for Medicare all the way until three months after I turn 65. Well, maybe. But after your employer coverage lapses, you will have no health insurance until you sign up for Medicare. If you roll the dice and say, I want to save a few months of that part B premium, and I’m not going to enroll in Medicare right away, if you have health issues or an injury, you wouldn’t have any health coverage. My advice to is never roll the dice and risk being uninsured.
Question: Talk for a minute about the consequences if you sign up after the seven-month enrollment window.
Answer: If you happen to enroll late, that is, your window closes, and you haven’t enrolled in Medicare, there are late enrollment penalties that involve both Part B and Part D. The late enrollment penalties for Part B are 10% added on to your monthly premium for each year you are late in enrolling. These are cumulative penalties, and they last as long as you have Part B coverage.
Part D penalties are different. They are monthly penalties. So, for each month you are late in enrolling in a Part D drug plan, you have to pay an additional 1% added on to the average Part D premium. These also are cumulative, and they last as long as you have a Part D plan. More people are exposed to the Part D penalties, but their financial impact is relatively less.
YOUR TURN
Are you applying for Medicare for the first time, or switching between plans? Share your experience in the comments!
Rodney A. Brooks is an award-winning journalist and author. The former Deputy Managing Editor/Money at USA TODAY, his retirement columns appear in U.S. News & World Report and Senior Planet.com. He has also written for National Geographic, The Washington Post and USA TODAY and has testified before the U.S. Senate Special Committee on Aging. His book, “The Rise & Fall of the Freedman’s Bank, And Its Lasting Socio-economic Impact on Black America” was released in 2024. He is also author of the book “Fixing the Racial Wealth Gap.” His website is www.rodneyabrooks.com
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