5 Mistakes You’re Making With Medicare Open Enrollment
Learn about the top 5 Medicare open enrollment blunders and how to manage your options to receive better coverage.
Millions of seniors are in the midst of Medicare open enrollment, which runs from October 15 through December 7, but many are finding the procedure difficult. According to a July 2022 research from health care consulting firm Sage Growth Partners, some consumers don't grasp the distinction between Original Medicare and Medicare Advantage, many are overwhelmed by Medicare advertising, and just 4 in 10 people check their plan alternatives each year.
This results in missed Medicare open enrollment opportunities, such as failing to ensure that your physicians are in-network for the next plan year and failing to compare your Medicare Part D prescription drug coverage to other available options.
Here are a few examples of common Medicare open enrollment mistakes:
1. Not checking your doctors for 2023
If you have a Medicare Advantage plan, you must generally seek medical care from providers in the plan's network, which might change at any time. Make sure your favorite medical providers are still in the plan's network in 2023 before deciding to stay with it.
Because websites and provider directories aren't always up to date, this may necessitate some labor on your behalf.
"I was just at a client, and [the plan] said their doctor wasn't in-network, and it took us calling the provider and looking up a different site on the network side," Evan Tunis, president of Florida Healthcare Insurance, explains. "I would recommend calling the doctor's office and simply confirming with them."
2. Not comparing prescription drug plans
Your prescription medication coverage is provided by a private insurance carrier, regardless of whether you have Original Medicare or Medicare Advantage, and it may change each year. In 2023, your usual prescription drug may cost more, or your insurer may refuse to cover it at all. (A different plan may cover it for less.)
It is worthwhile to enter your medications into Medicare.gov to see what plans are recommended for you. Pro tip: If you log in to your Medicare.gov account, your medication history is already there.
"It makes it much easier for them to shop for the next year," says Katy Votava, who holds a doctorate in health economics and nursing and is the president and founder of Goodcare, a Medicare consulting organization. "They don't have to tediously put everything in line by line and milligram by milligram."
3. Thinking all doctors will take your PPO plan
A preferred provider organization, or PPO, plan is a type of health insurance that permits members to see out-of-network providers for a fee. People frequently believe that since they have a Medicare Advantage PPO, they may see any doctor they desire. However, providers do not always accept out-of-network coverage.
"If providers don't want to bill the plan, they can simply refuse someone at the point of service," Tunis argues.
For example, the Mayo Clinic in Florida is out-of-network with most Medicare Advantage plans and will not book visits for people with such coverage.
Choosing Original Medicare plus Medicare Supplement Insurance, or Medigap, for full provider choice "is the most prudent solution," according to Tunis.
4. Being swayed by the splashy ads
Medicare open enrollment season means a rush of Medicare advertising, and Medicare Advantage plans have enticing features such as no premiums and some coverage for hearing, dental, and vision care.
However, purchasing for health insurance is about more than just the extra perks. "Most of the time, honestly," Votava says, "they don't cover that much dental." "Hearing aid coverage is also very limited, and this is not a reason to change your plan, so exercise extreme caution."
More importantly, according to Votava, ensure that the plan covers your doctors and prescriptions for the next year.
5. Waiting too long to ask for help
Medicare open enrollment closes on December 7, but you don't want to wait until the last minute, or even the last week, to begin your investigation. If you have any questions, you can seek assistance from programs such as the State Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can provide free guidance with your Medicare options, but they are often overburdened.
SHIP programs are filling up many weeks in advance in various regions of the country. "If you need help, don't wait," adds Votava.