Guest Columns

Medicare Open Enrollment: An autumn tradition?

Matthew Gallardo
Matthew Gallardo

For most, the fall season is synonymous with football, the beauty of autumn and everything and anything pumpkin flavored or scented. However, fall now includes a new seasonal tradition- shopping for the right Medicare plan during open enrollment season, which now runs each year from October 15 through December 7.

Medicare provides health insurance benefits to over 52 million seniors and disabled people in the US¹. And that number continues to balloon as nearly 10,000 baby boomers turn 65 every single day, thus becoming eligible for Medicare. Due to this surge, Medicare is continually changing and must evolve to remain sustainable. The health insurance landscape for seniors really began to change in 2006 with the implementation of the Medicare Part D drug program and proliferation of Medicare Advantage plans. Medicare Advantage plans were created as a more cost-effective type of Medicare health plan offered by private insurance companies that contract with and serve as a substitute for original Medicare, which then provides recipients with their Part A and Part B benefits.

The new normal

This relatively new autumn “tradition” continues to thrust its way into the lives of seniors and the disabled across the US year after year. In a matter of speaking, I'd say some may view open enrollment similarly to that of an annual health physical, “a very unpleasant, but very necessary deed.” 

Researching and (re)enrolling for a Medicare plan every fall is no fun, but again essential. It's not changing anytime soon. Ideally, this new normal was meant to give Medicare recipients more choice and the capability to do cost comparisons between plans that fit individual need and budget. However, the benefit of vast choice actually creates frustration and confusion for many and may cause “decision-making paralysis.” Research has found that because of this, many Medicare recipients just go with last year's plan because they feel it's too much effort to switch plans. That decision could come back to haunt them because their plan, that was perfect last year, now may have higher premiums and co-pays or may no longer really meet their specific healthcare needs. 

Undoubtedly, this labyrinth of terminology, benefit options, rules, penalties, and a myriad of forms can be staggering, especially if you're technologically challenged due to much of the research and registration options being online. But again, annual open enrollment is said to encourage Medicare recipients to spend their money more wisely, take better care of themselves, and get better personalized health coverage. It may also be said that our health and welfare should at least be worth this effort once a year. These are all great points, but we must find a happy medium.

Medicare recipients should take more responsibility for their choice of healthcare coverage and should feel fortunate to have these choices. However, the Centers for Medicare & Medicaid Services and private insurers need to streamline the process and make it a little easier, especially for seniors. Congress needs to enact legislation to consolidate Medicare Advantage and Part D plan choices and standardize options in order to facilitate informed decision-making by Medicare plan enrollees.² Though it is not an easy fix, it's one of a number of solutions out there. In particular, MedicareRights.com shares "50 Wishes for Medicare's Future," which details a number of ideas and solutions to fix Medicare and its delivery system.

Until that time, those eligible for Medicare can find help to make this process a bit easier to understand and navigate. MedicareInteractive.org provides a number of resources and tips, some of which include the following:

  • If enrollees want to join a stand-alone prescription drug plan (PDP), they can use the Plan Finder tool on Medicare.gov. The Plan Finder tool compares plans based on the drugs you need, the pharmacy you go to and your drug costs. And remember coverage changes every year. The cost of your medications may look very different from the year before.

  • If enrollees want to join a Medicare Advantage plan, they can call 1-800-Medicare or go to Medicare.gov to find out what plans are available in their area. Once they receive the list of plans, they can check the plan websites to see which best fits their needs and budget.

  • Call or visit the website of your State Health Insurance Assistance Program or SHIP. Your state SHIP can help you to understand all of your Medicare coverage options, and counselors are available to meet with enrollees one-on-one, in person at no cost.

For additional resources on Medicare, check out the links below:

¹CMS.gov

²medicarerights.org/50wishes/streamline-enrollment

Matthew J. Gallardo, BASW, CCP, is the Director of Community Engagement and Coaching at Messiah Lifeways in Mechanicsburg, PA.

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