Expert Advice on Navigating Medicare – Forbes Health

Expert Advice on Navigating Medicare – Forbes Health

Forbes Health Advisory Board member John Bulger, DO, is a board-certified internist with expertise in insurance, population health and quality improvement.

In a conversation with Forbes Health, Dr. Bulger and his colleague Roger van Baaren, chief sales officer at Geisinger Health Plan, discuss the 2023 Medicare open enrollment period and offer advice for older adults on how to pick the best coverage for one’s needs without overcomplicating the process.

In your experience, what tends to be the most complicated or confusing element of open enrollment for Medicare beneficiaries?

The most confusing part about shopping for Medicare is generally that there are so many plan options. Here in Pennsylvania, for example, most counties now have dozens of plans to choose from. The other confusing part about shopping for Medicare is the information overload from television, digital, print and direct mail advertising. Most shoppers need help filtering all of that information. Additionally, the differences between plans are small, but they can have a large impact on individual Medicare beneficiaries.

How can a beneficiary easily determine whether Original Medicare or Medicare Advantage is best for them and their needs?

Beneficiaries who don’t have coverage from a former employer or the Veterans Administration (VA) are required to have some kind of drug coverage, or they risk paying a late enrollment penalty if they need drug coverage later. Most Medicare Advantage plans have built-in drug coverage that satisfies this requirement, so that’s why Medicare Advantage can be such a good fit for many people.

Personal preference plays apart as well. Most Medicare Advantage plans have extra benefits like hearing, dental and vision that Original Medicare doesn’t cover. Some even offer coverage for meals, transportation and gym memberships. These “extras” are attractive to many beneficiaries. Lastly, Original Medicare doesn’t have a maximum out of pocket (MOOP), so if you have a catastrophic event, there’s no limit on what you could pay out of pocket. All Medicare Advantage plans have a MOOP, which gives many beneficiaries added peace of mind.

In terms of costs, what can Medicare beneficiaries expect to see in 2023 policies? Which costs generally increased and decreased compared to 2022?

Each year, the Centers for Medicare and Medicaid Services (CMS) determines payment rates for the following year. The payment rates for 2023 allowed Medicare Advantage plans to continue to invest in product benefits. There are already many plans with no premium (other than the monthly Part B premium, which all Medicare beneficiaries must pay), and many of those plans even added benefits in 2023. In general, most costs decreased for 2023.

How would you guide someone looking to pick the best plan?

I’d be sure to have them meet with an expert in person. They can either meet a local representative from health plans in their area or an independent broker. If they meet with a broker, they should be sure to ask that broker what plans they represent before meeting with that broker. You don’t want to meet with a broker who only can sell one or two plans because you might not get the best option for you.

In preparing for your meeting with a local representative or broker, make sure you have all of your prescription names and dosages written down, plus a listing of all of the doctors you see. You’ll want to be sure that any plan you consider covers your drugs and will let you see the doctors who have come to know you.

Lastly, I’d advise against calling the celebrity endorsed “hotlines.” You’ll likely get connected to someone in another state who really doesn’t understand the nuances of your local plans. And to put it nicely, your phone will ring for a long time afterward if you call them but don’t purchase a plan through them.

Any additional tips for picking a 2023 plan?

If you’re shopping with your spouse, don’t get hung up on having the same plan. The good thing about having so much choice is that there’s an optimal plan for everyone based on the drugs they take, the doctors they want to see and the benefits that are important to them. Each individual should make an individual choice.

Also, know that your decision doesn’t have to be permanent. If you like your plan, you can stay on it year after year without doing anything—you’ll never have to shop again. But if you don’t like your plan, you can either change during the Medicare open enrollment period (OEP) from January 1 to March 31, 2023, during which time you can change Medicare Advantage plans but not enroll in one for the first time , or you can change during the next annual enrollment period (AEP), which runs from October 15 to December 7, 2023.

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