It's Medicare Open Enrollment Time

Making the Right Choice During Medicare Open Enrollment

by Don Drake, Connelly Law Offices, Ltd.

Connelly Law Offices, Ltd. | Medicare Planning Process
Attorney RJ Connelly III

The time has arrived for open enrollment for Medicare 2023. It began on October 15 and will run through December 7. "Open enrollment", also known as Medicare's annual election period, permits plan enrollees to reevaluate their coverage – whether it’s Original Medicare with supplemental drug coverage or Medicare Advantage plans (MA) – and make changes or purchase new policies if they choose to do so.

"Buckle up your seat belt and prepare to be bombarded by an endless stream of commercials from aging television and sports stars pushing Medicare Advantage Plans," said certified elder law Attorney RJ Connelly III. "The problem is that much of what they promise is not available for most people and they create confusion for those who are new to the Medicare system. We'll discuss this a bit more later in this blog."

During the Medicare open enrollment period, you can also:

  • Switch from Original Medicare to Medicare Advantage (if you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).

  • Switch from Medicare Advantage to Original Medicare (plus a Medicare Part D plan, and a Medigap plan).

  • Switch from one Medicare Advantage plan to another.

  • Switch from one Medicare Part D prescription drug plan to another.

  • Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. If you haven’t maintained other creditable coverage, a late-enrollment penalty may apply.

What You Can't Do

The annual Medicare open enrollment period does not apply to Medigap plans, which are only guaranteed in most states during a beneficiary’s initial enrollment period or during limited special enrollment periods. If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to enroll. Instead, you’ll use the Medicare general enrollment period, which runs from January 1 to March 31.

Connelly Law Offices, Ltd. | Medicare Planning Process

Medicare’s general enrollment period is for people who didn’t sign up for Medicare Part B when they were first eligible, and who don’t have access to a Medicare Part B special enrollment period. It’s also for people who must pay a premium for Medicare Part A and didn’t enroll in Part A when they were first eligible.

If you enroll during the general enrollment period, your coverage will take effect on the first of July. Learn more about Medicare’s general enrollment period by clicking on the blue phrase.

The ABCs of Health Insurance

One last bit of information to provide before we get into the focus of this blog is understanding the differences between the acronyms of health insurance and what type of plan may make sense for you. Let's check them out:

  • Health Maintenance Organization (HMO) - HMOs are considered one of the least expensive types of health insurance. Its premiums are typically low, deductibles are affordable, and co-pays are fixed. With HMO plans, you are required to choose doctors within the network, including specialty providers. If you need a specialist, a referral from your primary care doctor is required. These are an excellent choice if you are on a fixed income and in decent health.

  • Point of Service plan (POS) - This plan also requires referrals from your primary care doctor to see a specialist. A POS has higher premiums than an HMO, but you can see providers outside of the network, but you will be paying a higher co-pay. This plan works for those who may have a condition and requires specialists who are not located within the area.

  • Exclusive Provider Organization (EPO) - This is a lesser-known plan but contains larger networks than HMOs. EPOs still only cover those within the network, and they may or may not require referrals to specialists. Premiums may be higher than HMOs.

  • Preferred Provider Organization (PPO) - These plans are usually more expensive than HMOs and POSs, but they allow you to see specialists without a referral. Copays and coinsurance for in-network providers are low and if you have a lot of health needs or know within the next year, your health will require more attention and you can afford higher premiums, a PPO is an excellent choice.

But Joe Namath Said...

With that out of the way, let's get back to Mr. Namath and his friends and what they are trying to sell you -- Medicare Advantage plans (MA). These plans, also known as Medicare Part C, began running their annoying commercials ad nauseam in late August and are only increasing in number as the enrollment period has started. What's important to know here is that these ads are not sponsored in any way by any government agency or Medicare itself, but by private insurers trying to sell a Part C product and the promises being made on these commercials do not represent, as the late Paul Harvey would say, "the rest of the story." Let's explore this further.

Connelly Law Offices, Ltd. | Medicare Planning Process
The operational word here is "may"

"Over the past weekend, I was watching a documentary on the history channel when ad after ad featuring older celebrities and retired sports figures aired touting free benefits that may be available from Medicare Advantage plans," said Attorney RJ Connelly III, who works with seniors and their families on health insurance and long-term care concerns. "As with all things that seem too good to be true, it's important to view these commercials with that adage in mind and listen very closely to the words that are being used." Attorney Connelly is certainly on the mark with that statement as the promises made may come at a price.

The Real-Life Story of Tom Mills

Last year, the website, MedPage Today, published a story about a San Diego man named Tom Mills who discovered one of the dirty little secrets about MA plans that offer low rates and, in some cases, no premiums -- that is until you get sick. At that point, out-of-pocket costs soar, and even worse, getting out of one can be even more expensive.

Connelly Law Offices, Ltd. | Medicare Planning Process
Not all costs are explained

After Mills underwent a mitral valve repair and suffered a mild stroke with no lasting effects, the San Diego resident's plan began charging him hundreds of dollars in monthly copays for drugs and other medical services. He also had to pay $295 a night for his hospital stays.

But then came the biggest shock of all for Mr. Mills when he learned that if he switched out of his MA plan, he would incur exorbitantly higher costs the next time he needed a serious medical intervention. If he moved to traditional Medicare and a prescription plan, he still needed a supplemental Medigap plan to pick up his 20% copays and deductibles.

Though the retired environmental geologist was healthy enough at that point to train for marathons after his medical emergency, he was now carrying the baggage of a pre-existing condition, which can be a problem when seeking a Medigap plan and these plan providers, in all but four states, can and do reject people like him or require prohibitively higher premiums. Diabetes, heart disease, or even a knee replacement can be criteria for exclusion. A health insurance broker told him no supplemental plan would cover him, and he'd be wasting his time if he applied. No one told him about this side of MA plans when he enrolled at age 65.

"So, we see Joe Namath and others tout MA's array of services - free dental, vision, hearing, gym membership, rides to medical appointments, doctor and nurse visits by phone, and even meal delivery and home aid," stated Attorney Connelly. "You hear plenty of the pros, but none of these celebrity endorsers ever list the cons, which can be life-altering for those on a fixed income."

"You hear plenty of the pros, but none of these celebrity endorsers ever list the cons, which can be life altering for those on a fixed income." --- Attorney RJ Connelly III