Since it’s Medicare open enrollment season, you’re likely to see a bunch of TV ads for private insurers’ Medicare Advantage plans and mailers to sign up for them and for Medicare Part D prescription drug plans. So, you might think that people 65 and older would be particularly acute about all things medical care.
In fact, several recent surveys show that most Medicare beneficiaries are completely confused about Medicare coverage and costs.
For example, in a MedicareAdvantage.com poll of 2,013 people ages 65 to 99, 65% of Medicare beneficiaries said the government health insurance program was confusing and difficult to understand. This is the third year the site has conducted a similar survey, and confusion about Medicare has increased each time.
Medical care confusion: ‘Surprising and alarming’
“It’s both surprising and worrying,” says Christian Worstell, who conducted the latest survey. “I write about Medicare as my full-time job, and I agree it’s confusing. Imagine how confusing it is for someone who doesn’t read, research, and write about it every day.
In a Retirement Living survey of 351 beneficiaries of private insurers’ Medicare Advantage plans (the alternative to original Medicare), only 44% said they fully understood their plan. One in eight misinterpreted aspects of their plan after enrolling.
But, Worstill says, “Knowledge is power when it comes to making the most of your benefits and enrolling in the right coverage that fits your needs.”
When Medicare beneficiaries or people about to enroll in Medicare don’t understand how it works, they may end up paying more for their health care than necessary and miss out on the coverage available to them.
In fact, a Retirement Living survey found that 51% of Medicare Advantage beneficiaries said their confusion led to unexpected bills for uncovered services, and 46% of them said they had higher-than-expected out-of-pocket costs.
Ari Parker, co-founder of Medicare Advisory Services, is also surprised by how little older Americans know about Medicare.
“If they know where to go to find information, it’s not that complicated,” he says.
medical careMany moving parts
Others may disagree that medical care is not that complicated. It is considered:
The original Medicare law and subsequent rules are formidable. According to Parker’s own book, It’s Not That Complicated: The 3 Medicare Decisions to Protect Your Health and Your MoneyThe Medicare Establishment Act of 1965 was over 1,400 pages long and tens of thousands of pages of rules and regulations have been added since then. Parker wrote that when President Lyndon Johnson tried to explain his new Medicare program to reporters, he distorted it so much that the White House press secretary had to persuade the media to retract his description.
Medical care is like a train running on two tracks. One is Original Medicare, which includes Part A (hospital insurance) and Part B (doctor visits, home health care, medical equipment, and preventive services). The other is Medicare Advantage (Part C), which includes original Medicare coverage that does not include a limited network of doctors and hospitals. There will be 3,959 Medicare Advantage plans nationwide in 2024; The average Medicare beneficiary will have access to 43, according to the health policy research and news organization, KFF.
You need to understand all parts of Medicare — A, B, C, and D. To get Part C or D, you need to shop around health insurance companies and compare costs and benefits. There will be 709 standalone prescription drug plans for people with original Medicare in 2024; KFF says the average patron will have a choice of approximately 60 options.
Then there is another insurance policy you can purchase to help pay for Parts A and B. It’s a Medicare Supplement policy, or Medigap, and you need to shop around if you want that, too.
In addition, Medicare has five enrollment periods: Open enrollment From October 15 to December 7; Initial registration (three months before you turn 65 and up to three months after your birth month); The eight months Private registration After you lose health insurance from your employer or your spouse and the periods from January 1 to March 31 –public registration, If you do not enroll in Medicare Part B during initial enrollment and are not eligible for special enrollment and Enroll in Medicare Advantageif you are on a Medicare Advantage plan and want to switch to another plan or drop it and enroll in Original Medicare.
As Worstl says: “There are a lot of moving parts; If, but and but. There are a lot of terms and exceptions. “Does Medicare cover this?” Well, yes, but only if the following 11 things are true.
Worstell points out that health insurance itself can be confusing and that the overlay of Medicare adds to the public’s insurance culture problems.
What people don’t know about medical care
So what do people who qualify for or on Medicare get confused or get wrong? Here are six examples:
1. Discount (discounts
49% of Medicare beneficiaries surveyed by MedicareAdvantage.com believe that Medicare does not charge a deductible (what you pay out of pocket before coverage begins) for inpatient care. Yes it is.
The Part A deductible would be $1,632, and the Part B deductible would be $240. Part C deductibles vary based on your Medicare Advantage plan. “I think you definitely want to know before you go to the hospital that you’re going to be on the hook for $1,600,” Worstill says.
2. Doctor’s fees
When current beneficiaries or people about to enroll in Medicare don’t understand how it works, they may end up paying more for their health care than necessary. This is called an “excess charge” and can amount to an additional 15% of the doctor’s bill.
3. Mental health benefits
More than two-thirds (71%) did not know that Medicare covers inpatient and mental health treatment. “It’s alarming to think about how many people might need mental health treatment and aren’t seeking it because they think Medicare won’t cover it and they don’t want to pay for it out of pocket,” says Worstell.
4. Assistive devices
Only 29% knew that original Medicare typically covers walkers, walkers, and wheelchairs. “I think most people don’t associate equipment, appliances, and insurance,” Worstill says.
5. Plan Changes
In a Commonwealth Fund survey of people over 65, 54% weren’t sure how difficult it would be to switch from Medicare Advantage to traditional Medicare and get a Medigap policy. Another 21% did not know this was an option.
6. Incidental costs
A 2023 KFF poll found that only 34% of people over 65 knew there was a federal law (the Inflation Reduction Act of 2022) that limits out-of-pocket prescription drug costs for people with Medicare.
Learning the ins and outs of medical care can be intimidating and “not fun,” says Worstell. “No one likes to sit and waste all these benefits and costs,” he adds.
Where to learn about medical care
There are a fair number of places you can take advantage of Medicare, although beneficiaries rarely use many of them, according to a MedicareAdvantage.com survey.
Some of the best Medicare resources
Medicare.gov. This is the official government website that explains how Medicare works and how to enroll in or switch plans. It also has a useful Medicare Plan Finder tool that lets you find and compare Medicare Advantage plans, Part D drug plans, and Medigap policies.
1-800-Medicare (800-633-4227). It’s a toll-free Medicare number where you can talk to someone to get your questions answered. A Medicareadvantage.com article on the subject says the quickest way to access the phone tree of this toll-free number for help is to say “Coverage and Benefits” or press 5 on your phone keypad.
Government is free Medicare and You 2024 booklet. You can read it online or get a copy in the mail. This guide is written in plain English and contains a useful index.
Government ship programs. SHIPs (full name: State Health Insurance Assistance Programs) provide free, unbiased telephone assistance about medical care from state government experts.
Medicare intermediaries and agents. They sell Medicare Advantage plans, Part D prescription drug plans, and Medigap policies and are paid by insurance companies.
Medical care books and websites. Three useful books are Medical care for you By Diane Omdahl, Get what’s right for you for Medicare By Philipp Muller and It’s not that complicated By Ari Parker. Sites worth checking out are those at Chapter, which has a free Medicare decision worksheet you can download) and Hello Medicare; Both sites also sell Medicare policies.