Since it’s Medicare open enrollment season, you may see a lot of television ads for private insurance companies’ Medicare Advantage plans and mailer ads for enrolling in that plan and Medicare Part D prescription drug plans. So you might think that people 65 and older would be especially keen on all things Medicare.
In fact, several recent surveys show that most Medicare beneficiaries are quite confused about Medicare coverage and costs.
For example, a MedicareAdvantage.com survey of 2,013 people ages 65 to 99 showed that 65% of Medicare beneficiaries said government health insurance plans are confusing and difficult to understand. This is the third year the site has conducted a similar survey, and each time confusion about health insurance comes up.
Medicare chaos: ‘Surprising and disturbing’
“It’s both surprising and disturbing,” said Christian Worstell, who recently conducted the survey. “I write about health insurance as my full-time job, and I agree it’s confusing. Imagine how confusing it is for someone who doesn’t read, research, and write about it every day.”
In a retirement living survey of 351 beneficiaries of private insurance companies’ Medicare Advantage plans, the alternative to original Medicare, only 44 percent said they fully understood their plans. One in eight people misunderstood aspects of their program after signing up.
But, Worstel said, “knowledge is power when it comes to taking advantage of your benefits and getting the right coverage for your needs.”
When Medicare beneficiaries or people about to enroll in Medicare don’t understand how it works, they can end up paying unnecessary medical bills and missing out on available coverage.
In fact, Retirement Living’s survey found that 51% of Medicare Advantage beneficiaries said their confusion resulted in unexpected bills for non-covered services, and 46% said their out-of-pocket costs were higher than expected.
Ari Parker, co-founder of the Medicare Advisory Service chapter, is also surprised how little older Americans know about Medicare.
“It would be less complicated if they knew where to look for information,” he said.
medical insurancehas many moving parts
Others may disagree that Medicare isn’t that complicated. consider:
The original Medicare law and subsequent rules were huge. According to Parker’s own book, It’s not that complicated: Three health insurance decisions to protect your health and moneyThe Medicare law enacted in 1965 is more than 1,400 pages long, and tens of thousands of pages of rules and regulations have been added since. Parker writes that when President Lyndon Johnson tried to explain his new health insurance plan to reporters, he botched it so badly that the White House press secretary had to have the press retract his description.
Medicare is like a train running on two tracks. One is original medical insurance, which includes Part A (hospital insurance) and Part B (doctor visits, home health care, medical equipment and preventive services). The other is Medicare Advantage (Part C), which includes coverage that Original Medicare doesn’t offer with a limited network of doctors and hospitals. In 2024, there will be 3,959 Medicare Advantage plans nationwide; Medicare beneficiaries will receive an average of $43, according to KFF, a health policy research and news organization.
You need to know all the parts of Medicare—A, B, C and D. To get Part C or D, you need to choose between health insurance companies and compare costs and benefits. By 2024, 709 stand-alone prescription drug plans will be available to Original Medicare enrollees; KFF said the average beneficiary will have nearly 60 options.
You can then buy another policy to help cover the costs that Part A and Part B don’t cover. This is a Medicare supplement policy, or Medigap, so you’ll need to shop around if you want one.
Additionally, Medicare has five enrollment periods: Open Enrollment October 15 to December 7; Initial registration (three months before you turn 65 to three months after your birthday month); eight months special admissions After you lose your employer or spouse’s health insurance and during the two periods between January 1 and March 31—General Admissions, If you did not sign up for Medicare Part B during initial enrollment and are not eligible for special coverage, and Advantages of medical insuranceif you are already in a Medicare Advantage plan and want to switch to another plan or drop the plan and join Original Medicare.
As Wostel said: “There are a lot of moving parts; ifs, ands and buts. There are a lot of clauses and exceptions. “Does Medicare cover this? Well, yes, but only if the following 11 things are true. “
Vostel noted that health insurance itself can be confusing, and Medicare coverage only adds to the public’s insurance literacy problem.
What people don’t know about health insurance
So, are people confused or wrong about who qualifies for or is covered by Medicare? Here are six examples:
A MedicareAdvantage.com survey shows that 49% of Medicare beneficiaries believe Medicare does not charge a deductible (the amount you pay out of pocket before coverage begins) for hospital care. Indeed.
The Part A deductible is $1,632 and the Part B deductible is $240. Part C deductibles vary by Medicare Advantage plan. “I think before you go to the hospital, you want to know that you’re going to be responsible for $1,600 in costs,” Worstell said.
2. doctor fees
When current beneficiaries or those about to enroll in Medicare don’t understand how it works, they can end up paying unnecessary amounts for health care. This is called an “excess charge” and can be up to 15% of the doctor’s bill.
3. Mental health benefits
More than two-thirds (71%) don’t know that Medicare covers hospitalization and mental health treatment. “It’s disturbing how many people may need mental health treatment but don’t seek it because they think Medicare won’t cover it and don’t want to pay out of pocket,” Vostel said.
4. Auxiliary equipment
Only 29% knew that Original Medicare typically covers walkers, rollators and wheelchairs. “I think most people don’t really connect equipment and fixtures to insurance,” Vostel said.
5. Plan changes
In a Commonwealth Fund survey of people over 65, 54% were unsure how difficult it would be to switch from Medicare Advantage to traditional Medicare and get a Medigap policy. Another 21% didn’t even know it was an option.
6. Out-of-pocket expenses
A 2023 KFF survey found that only 34% of people over 65 knew there was a federal law (the Inflation Reduction Act of 2022) that limits the out-of-pocket prescription drug costs for people on Medicare.
Learning the ins and outs of Medicare can be intimidating, and “it’s not fun,” Vostel said. “No one wants to sit down and think through all these benefits and costs,” he added.
Where to find out about health insurance
According to MedicareAdvantage.com, there are still many places where Medicare could be strengthened, even though beneficiaries rarely use many of them.
Some of the Best Health Insurance Resources
Medicare.gov. This is the official government website that explains how Medicare works and how to sign up or switch plans. It also has a helpful Medicare Plan Finder tool that lets you find and compare Medicare Advantage plans, Part D drug plans, and Medigap policies.
1-800-Medical Insurance (800-633–4227). This is Medicare’s toll-free number where you can speak to a human to get answers to your questions. A related article from Medicareadvantage.com says the fastest way to get help through this toll-free number’s phone tree is to say “Coverage and Benefits” or press 5 on your phone’s keypad.
government free Medical insurance and you 2024 manual. You can read it online or get a copy mailed to you. This guide is written in plain English and has a helpful index.
national ship plan. SHIP (State Health Insurance Assistance Program) provides free, impartial telephone assistance about Medicare from state experts.
Health insurance brokers and agents. They sell Medicare Advantage plans, Part D prescription drug plans and Medigap policies, and are paid by insurance companies.
Medicare books and websites.Three useful books are Medical insurance for you by Diane Omdahl, Get your Medicare Philip Moeller and Not that complicated Author: Ali Parker. Sites worth checking out include Chapter (which has a free Medicare decision worksheet you can download) and Hello Medicare; both sites also sell health insurance policies.