Last Wednesday we held an informational virtual town hall on the topic of Medicare open enrollment for Medicare insurance plans. We invited two experts to join me to discuss the dos and don’ts of this important enrollment period and to discuss how seniors feel about open enrollment and the different benefits that could be available in this year’s plans.
I started off by recognizing the amount of advertising and information that we get this time of year and reminded all of us that healthcare is complicated, but we shouldn’t let this deter us from doing the research needed to get us the best insurance plan that fits our individual needs.
The first panelist was Amy Gotwals who has 22 years of experience serving older Americans with 16 years spent at US Aging. She is Chief, Public Policy and External Affairs. She discussed some of the dos and don’t of finding the right insurance plan.
The second panelist was Dr. Justin Barclay who is a veteran of analytics and program evaluation and is Tivity Health’s Vice President of Analytics, Consumer Research, and Data Strategy. Dr. Barclay reviewed a Tivity Health survey that measured seniors’ attitudes about open enrollment and the benefits offered.
Amy began by pointing out the things that we can do during open enrollment which started on October 15th and ends on December 7th.
- You can add, drop or change your Medicare Advantage and Part D coverage
- You can switch from Original Medicare to a Medicare Advantage (MA) plan, or switch to Original from MA
- Depending on your state, you may be able to buy a Medigap plan during this period
She then detailed the things that we should do.
- Consider your current needs (what’s changed since last year in your life and health?)
- Investigate your new options
- Even if you’re satisfied with your coverage, check to see if there is another plan offered in your area that offers health or drug coverage at a better price
A recent Kaiser Family Foundation report found that, for 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans—more than double the number available in 2017. Shopping may be worth it!
- When evaluating plans/options, consider:
- Access to providers and pharmacies you want to use
- Access to benefits and services you need
- Total costs for insurance premiums, deductibles and cost-sharing amounts
- Check your eligibility for Medicare Savings Programs, which can help you with premiums and other costs.
Enrollment assistance is available in your community and 24 hours a day, 7 days a week at 1-800-MEDICARE to connect you to coverage that best fits your needs and budget.
She then gave us some ideas on where we can find the information we need to make this important decision.
- If you have Original Medicare, go to www.medicare.gov or read the 2022 Medicare & You handbook.
- Sent to everyone enrolled in Medicare
- Includes information about Medicare-covered services
- Lists Medicare Advantage Plans and Part D plans in your area
- If you did not receive a Medicare & You handbook, you can call 1-800-MEDICARE to request that your region’s copy be sent to you.
- If you have an MA plan or standalone Part D plan, look to your Annual Notice of Change and Evidence of Coverage documents, which list any changes for your plan in 2022. Pay special attention to the plan’s costs, benefits and coverage rules and the formulary (list of covered drugs).
- You can also contact a plan directly with questions; get everything in writing.
- Before joining a new plan, call your doctors to make certain they are in the provider network!
Amy then detailed some places we can get help with the decision process.
- www.medicare.gov or 1-800-MEDICARE
- For one-on-one help, find your local State Health Insurance Assistance Program (SHIP); SHIPs are federally funded to provide trusted, unbiased Medicare counseling. www.shiphelp.org or 877-839-2675 to find your local SHIP
- You can find SHIP contact info and other local aging resources via the Eldercare Locator, eldercare.acl.gov or 800-677-1116 (also federally funded, administered by USAging)
She then pointed out some things we should avoid/watch out for.
AVOID/WATCH OUT FOR
- During Open Enrollment, there is a higher risk of fraudulent activity.
- Medicare has rules for how plans can and cannot communicate with you (for example, a plan cannot call or email you if you did not ask them to do so or if you have no prior relationship with them).
- Beware of any pressure to join a particular plan, or scammers saying they are with Medicare, threaten to take your benefits, etc.
- If you feel you may be experiencing fraud, abuse or errors, contact your Senior Medicare Patrol (SMP).
- SMP representatives can teach you how to spot and protect yourself from potential Medicare fraud.
- www.smpresource.org, 877-8082468 to contact your local SMP
Amy recognized that it is no small task to arrive at the right decision, but it is important to our health and can save us money. She wished us good luck and good health.
Dr. Barclay works at Tivity Health which offers health programs, like Silver Sneakers, for seniors. He discussed a Tivity Health survey that measured the attitudes of seniors toward open enrollment and the benefits offered by many Medicare Advantage plans. This survey only applies to Medicare Advantage plans.
He started out by pointing out that a majority of seniors (72%) do not plan on attending a Medicare Open Enrollment event this year. COVID-19 might have had some impact on these numbers, but it is still amazing that almost 3 out of 4 seniors aren’t going to take advantage of these great sources of information.
When asked how they would enroll, 37% of seniors had not made up their mind. I think it is important to note that 5% were going to enroll in person, 14% by phone, but 26% were going to register online. I think people continually underestimate the number and speed that older Americans are embracing technology.
Dr. Barclay then showed the results of how seniors rated the different benefits and decision criteria of plan selection.
The five main decision criteria, they are 20% higher than the rest, give a good indication of where are focus should be as we select our insurance plan. These are:
- Prescription drug coverage
- Benefit design (i.e., co-pays/deductibles)
- Network of health care providers
- My medical condition or preferences
The survey also revealed that 65% of seniors are unlikely to switch their insurance plan. I hope that this is due to their satisfaction with the plan and not the fact that they just don’t want to take the time to find a better plan.
For those that did decide to switch plans, 53% said the reason was lower co-pays and deductibles.
The survey then asked which benefits were included in their Medicare Advantage plan.
I was amazed at the different benefits that were available. While all of these benefits probably aren’t available on any one plan, it was amazing at the wide range of benefits, some of them not directly healthcare related. Dr. Barclay identified non-medical transportation services as one of these non-healthcare benefits.
The next question dealt with which benefits would they use the most if it was available in their insurance plan.
While eye and dental insurance were at the top of the list, hearing aid coverage was 7th. It is interesting to note that the addition of dental, eye and hearing aid benefits have been discussed in the pending Build Back Better legislation but the version that was just passed by the House and sent to the Senate only included the addition of hearing coverage.
Dr Barclay then showed breakouts of the above questions by demographics. They used:
- Gym goer or non-gym goer
You can find these slides here
We then had some time for questions. The first question asked was:
Question – I recently helped a family member who had an MA plan in one state move to a new state. Are there issues or concerns that are important to pay attention to when someone moves from one state to another?
Amy said that there are usually differences between states and that the SHIP people in the new state would be a great resource to understand those differences. I mentioned that I had moved to a different state a few years ago and found that there was a Medicare Advantage program in the new state that fit my requirements.
Question – Is Medicare.gov still the best plan comparison tool in your opinion?
Amy said that the tool is a very important tool in the decision process and works well for most people. I said that at first it wasn’t very good but over the years they have worked hard to improve it and it’s now pretty efficient.
Question – Mail order delivery still seems to vex some seniors. They like the idea of the monthly pharmacy visit. Is there is a way to assist seniors to consider a 90-day supply via the mail?
Amy pointed out that while mail order delivery is very convenient, some seniors enjoy the interaction with the pharmacist. I pointed out that seniors have a great deal of respect for their pharmacist, and they see their pharmacist much more often than their doctor. I have advocated for years that pharmacists should be paid for this important service of giving advice and help to seniors.
The town hall gave out some very important information and I hope it gave you all some help as you make important healthcare decisions during this open enrollment period.