Untangling Medicare During Open Enrollment

It is that time of year again, and this season feels especially complicated, another sign of how badly the nation’s health care system is working even for people who are guaranteed Medicare coverage.

Medicare’s annual Open Enrollment period runs through Dec. 7, giving beneficiaries a window to review their current coverage and make changes for the coming year, if they are eligible and choose to do so.

The process can be confusing because there is Medicare coverage, and then there are several different kinds of Medicare coverage — and the choice can have a major effect on how care is accessed and how much it costs.

Even among people who know the system, including some who have been on Medicare, there is a common misconception that Medicare is free. It is not. Everyone pays a basic premium for Medicare Part A, the simplest and least complete option.

Beyond that, additional coverage such as Medicare Parts B and D for prescription drugs, Medicare Advantage plans offered by insurers, Medicare supplement plans known as Medigap, and other premium options all cost more. They also come with a bewildering set of rules that can vary depending on where a person lives and which providers serve the area. Choosing among them, and estimating the cost of each, is complicated even for people who understand the basics and can balance premiums against possible benefits. In the end, the decision depends on predicting future health care needs, something few people can do confidently from year to year.

For people who are unfamiliar with the system, or who do not have the time, patience, or resources to study it carefully, the experience can become a frustrating maze. This year’s review is even harder because some plans people have depended on are undergoing major changes, which forces difficult decisions.

I am among the millions across the country trying to sort through the information, with some help, and I recently received a letter saying that my Medicare Advantage plan will no longer be offered in the future. My provider system and the national insurer behind the plan have split, and the breakup does not appear to be friendly. I was also told that I have a special right to buy a Medigap policy because the Advantage plan is going away. If I do not, I will go back to original Medicare at the start of the next year.

That creates a scramble over what to do next. Without going into every detail, my partner faces a similarly complicated process, and even after extensive research she still has not fully determined what her choices are or how to act on them. She keeps running into conflicting information.

It is a genuinely unhealthy predicament. A flood of information and a looming deadline add stress and anxiety, especially when the decision carries so much weight.

Help is available, if people are willing to read carefully, spend time on the phone with providers or Medicare staff, or watch the many informational videos available online. Many of those tutorials are created by brokers who hope to make a sale while guiding viewers toward what they believe is the best choice. That is common, and there is nothing wrong with it. They often know the system well, and many of the presentations are clear and direct, even if the final decision still rests with the individual.

In the Methow Valley, two Medicare Open Enrollment assistance events will be held at the Winthrop library, with trained volunteer Medicare counselors from SHIBA, the Statewide Health Insurance Benefits Advisors, available on a first-come, first-served basis to answer questions and offer personalized guidance. For more information about Medicare Open Enrollment, visit the Washington State Office of the Insurance Commissioner’s Medicare resources page.

Even worse may be ahead when major Medicaid cuts affect many people who most need care later on. Those reductions are likely to shake the entire medical care system. Recovering from that will require political will that has not been seen before, along with public pressure that has not been organized well enough. For now, the system is likely to get sicker before it gets better.