Your time to review 2021 Medicare coverage is running out. Here’s why that matters

Betty Newbold’s daughter helped her sign up for traditional Medicare and prescription drug coverage years ago. Newbold, 82, relies on her to manage the coverage, including seeing that copayments and deductibles are paid.

She’s among millions who trust adult children and other family members to help with important financial decisions.

Another Wasatch Front resident, Richard Scott, 92, signed up for Medicare A, B and D plans and has a great Medigap supplement through his former employer, so he hasn’t made any changes, despite the annual opportunity Medicare enrollees have to reconsider plan choices.

Medicare is the federal government’s insurance program, primarily for those 65 and older. The open enrollment window closes Dec. 7 for 2021. And experts lament the fact that many older adults don’t review choices to ensure they buy the best options for their situation.

Traditional Medicare and additions available through private companies, including prescription drug coverage, supplemental coverage and Medicare Advantage plans are complex, with many moving parts depending on one’s health and even where a person lives — factors that can change one year to the next.

Experts told the Deseret News that those who never look at what’s changed or consider new options may pay hundreds or even thousands of dollars more than necessary. Among the reasons:

• A person’s health and needs may change.
• Traditional Medicare (Plan A for hospitalization and Plan B for doctors and other covered outpatient services) doesn’t pay for dental, hearing or vision services. But those are among offerings that some Medicare Advantage plans purchased from nongovernment insurers include, in different combinations.
• Plans may change, year to year, adding or dropping services.
• There’s considerable variation in prices for Medigap supplement insurance to help with copays, deductibles and coinsurance and in prescription drug plans. Both are offered by private insurers.
• What’s covered in one plan may not be included in another.
• Sticker shock can be very real in a new year for those who didn’t pay close attention to changes — like rising costs for services or specific doctors or medications a policy no longer covers.

But Kaiser Family Foundation said 57% of Medicare enrollees don’t compare options every year; many never do. Kaiser found fewer than 1 in 10 enrolled in drug coverage or a Medicare Advantage plan voluntarily switched.

Experts say those who rely on Medicare may simply have found making initial choices overwhelming and are loathe to go through it again.

Cobi Blumenfeld-Gantz, co-founder and CEO of Chapter, a free service to help folks weigh Medicare-related options, said several factors discourage people from reviewing options periodically.

With so many insurance carriers and different types of plans and advisers, they may not know who to trust, he said. Rules vary in different states and so much depends on local offers and personal health that “it’s not the type of insurance that you can just ask your neighbors about.”

He also noted that people who simply go online to shop options may be using “antiquated technology” that doesn’t show a broad range of choices or doesn’t do much to help make decisions.

Family members can be a vital help to older adults, but they are sometimes overwhelmed by the choices, too.

Finding help

There are a number of ways to get help with making Medicare decisions.

Lots of older adults, like Newbold, rely on family members and are happy with the result.

“I’m just glad I have a daughter I can rely on,” she said.

Many others rely on the basic tool on Medicare.gov that shows plans based on input factors.

Others seek personalized help from their local, federally funded State Health Insurance Assistance Program, where trained consultants can answer questions and help sift choices. Salt Lake County Aging Services, for instance, houses such a program, which offers personalized help.

Still others choose professional insurance agents. Christian Worstell, a licensed health insurance agent with MedicareAdvantage.com, said agents can only market plans from carriers with whom they contract, but many work with multiple insurance companies “and can provide a comprehensive review of plan options for almost any area.”

Chapter’s free guidance was born of a man’s desire to help his older relatives and others like them. Blumenfeld-Gantz watched his mom try to help his grandfather wrestle with Medicare coverage decisions. Later, his parents were similarly frustrated, he said — even before they learned they were paying larger monthly premiums than necessary. Blumenfeld-Gantz used his expertise as a software developer to create the Chapter smart tool — available at getchapter.com — which considers individual needs, always followed by a phone consultation.

Benefits, participating providers and pricing structure are vital factors Worstell tells older adults and their families to consider first.

“Each plan will come with its own list of participating providers. I urge customers to consider plans accepted by their favorite doctor and nearest pharmacy. Comfort and convenience go a long way with health care,” Worstell said.

Different in 2021

Among 2021 changes that David Haas, co-founder of Elite Insurance Partners, a resource center for Medicare beneficiaries, noted in Forbes: The Centers for Medicare and Medicaid Services, which administers Medicare, said those who choose a Medicare Advantage plan in place of traditional Medicare will find between 4,800 different plans for 2021.

About a third of Medicare’s 63 million enrollees have Advantage plans, while the rest are stuck with Parts A and B.

While Medicare B premiums will rise a few dollars, Medicare Advantage plan premiums are expected to be slightly lower. However, the out-of-pocket costs for Advantage plans will increase from $6,700 to $7,550.

Among other changes, the Medicare website notes that many Medicare Advantage plans and Part D drug plans will cap the insulin copay at $35 and that end-stage renal patients will now be able to enroll in Advantage plans.

Choosing an Advantage plan during this open enrollment comes with time-limited buyer’s remorse. You can change your mind between Jan. 1 and March 31.

Trade-offs

Traditional Medicare covers 80% of what the program deems the allowable cost for a specific service or treatment. There’s no limit on how much a patient might be required to pay “out of pocket.”

Though Medigap insurance isn’t subject to the open enrollment period ending next week, folks may benefit from making all their Medicare-related decisions at once instead of piecemeal.

Supplemental insurance doesn’t cover services not covered by traditional Medicare, including vision and dental, though some Medicare Advantage plans do. Medigap plans for new enrollees won’t cover medications, though folks who have the benefit can keep it as long as they keep that plan.

Couples who want Medigap insurance must buy separate policies. Scott got his supplement through his former employer; his wife Judy bought her policy elsewhere and the coverage is very different, he said.

Trade-offs are common. Less expensive plans typically expect the enrollee to pay more of care’s cost.

Timing matters, too. Someone who doesn’t sign up for a prescription drug plan when he’s first eligible will pay more — a penalty that continues — if he later decides he needs it.

And when someone seeks supplement insurance in the first six months of signing up for Part B Medicare, health doesn’t matter. But most states let private insurers reject those with expensive medical conditions if they want when a person tries to buy a supplement later.