Medicare confusion is hurting your health and costing you money. Experts help explain what you need to know

Since it’s Medicare Open Enrollment season, you’ll likely see a lot of TV ads for private insurers’ Medicare Advantage plans and mailers to enroll in them and Medicare Part D prescription drug plans. So, you might think that people 65 and older would be especially wary of all things Medicare.

Wrong.

In fact, several recent studies show that most Medicare beneficiaries are quite confused about Medicare coverage and costs.

For example, in a MedicareAdvantage.com survey of 2,013 people aged 65 to 99, 65% of Medicare beneficiaries said the government’s health insurance program was confusing and difficult to understand. This is the third year the site has conducted a similar survey and confusion about Medicare abounds each time.

Medicare confusion: ‘surprising and disturbing’

“It’s equal parts surprising and disturbing,” says Christian Worstell, who conducted the recent survey. “I write about Medicare as my full-time job, and I agree that it’s confusing. Imagine how confusing it is for someone who doesn’t read about it, doesn’t research it and writes about it every day.”

In a Retirement Living survey of 351 beneficiaries of private insurers’ Medicare Advantage plans (the alternative to Original Medicare), only 44% said they fully understood their plan. One in eight misinterpreted aspects of their plan after enrollment.

But, Worstell says, “knowledge is power when it comes to making the most of your benefits and enrolling in the right coverage that fits your needs.”

When Medicare beneficiaries or people who enroll in Medicare do not understand how it works, they can end up paying more for their health care than necessary and miss out on the coverage that is available to them.

In fact, the Retirement Living survey found that 51% of Medicare Advantage beneficiaries said their confusion led to unexpected bills for uncovered services and 46% said they had higher out-of-pocket costs. higher than expected.

Ari Parker, co-founder of the Medicare Advisory Service Chapter, is also surprised at how little older Americans know about Medicare.

“If they know where to turn to find information, it’s not that complicated,” he says.

MedicareThere are many moving parts

Others may disagree that Medicare is not that complicated. Consider:

The original Medicare law and subsequent regulations are massive. According to Parker’s book, It’s not that complicated: the three Medicare decisions to protect your health and money, the 1965 law creating Medicare was over 1,400 pages long and tens of thousands of pages of rules and regulations have been added since then. Parker wrote that when President Lyndon Johnson tried to explain his new Medicare program to reporters, he ate it up so much that the White House press secretary had the media rewrite his description.

Medicare is like a train that runs on two tracks. One is Original Medicare, 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 Original Medicare does not have with a limited network of doctors and hospitals. There will be 3,959 Medicare Advantage plans nationwide in 2024; the average Medicare beneficiary will have access to 43, according to health policy research and news organization, KFF.

You need to understand all parts of Medicare – A, B, C and D. To get Part C or D, you need to shop between health insurance and compare costs and benefits. There will be 709 stand-alone prescription drug plans for people with Original Medicare in 2024; the average beneficiary will have a choice of nearly 60, says KFF.

Then there is another insurance policy you can buy to help pay for what Parts A and B don’t have. It’s a Medicare Supplement policy, or Medigap, and you need to shop around if you want one too.

In addition, Medicare has five enrollment periods: Open Enrollment from October 15 to December 7; Initial registration (Three months before turning 65 to three months after the birthday month); the eight months Special registration after losing health insurance from your employer or your spouse and the two periods from January 1 to March 31—general registration, if you did not enroll in Medicare Part B during initial enrollment and did not qualify for special enrollment and Enrollment in Medicare Advantageif you are in a Medicare Advantage plan and want to switch to another or drop out and enroll in Original Medicare.

As Worstell says, “There are a lot of moving parts; ifs, ands and buts. There are a lot of terms and exceptions.” Does Medicare cover this? Well, yes, but only if the following 11 things are true.

Worstell notes that health insurance itself can be confusing and the Medicare overlap only adds to the public’s insurance literacy problems.

What people don’t know about Medicare

So, what are the people eligible for, or in, Medicare confused or wrong? Here are six examples:

2. Doctor’s fees

When current beneficiaries or people who are about to enroll in Medicare do not understand how it works, they can end up paying more for their health care than necessary. This is called an “excess charge” and can be up to an extra 15% of the doctor’s bill.

3. Mental health benefits

More than two-thirds (71%) of them do not know that Medicare covers mental health and inpatient treatment. “It’s troubling to think how many people may need mental health treatment and they don’t seek it because they think it won’t be covered by Medicare and they don’t want to have to pay for it out of pocket,” says Worstell.

4. Assisted devices

Only 29% knew that Original Medicare typically covers walkers, rollators and wheelchairs. “I think most people don’t really associate equipment and devices with insurance,” says Worstell.

5. Plan changes

In a survey of people 65+ by the Commonwealth Fund, 54% were not sure how difficult it would be to switch from Medicare Advantage to traditional Medicare and get a Medigap policy. Another 21% didn’t know it was even an option.

6. Out-of-pocket costs

A 2023 KFF poll found only 34% of people over 65 knew there is a federal law (Inflation Reduction Act of 2022) that limits prescription drug costs for people with Medicare.

Learning the ins and outs of Medicare can be intimidating and “it’s not fun,” says Worstell. “No one likes to sit down and throw out all these benefits and costs,” he adds.

Where to learn about Medicare

There are a few places to bone up on Medicare, though beneficiaries rarely use many of them, according to a MedicareAdvantage.com survey.

Some of the best Medicare resources

Medicare.gov. This is the official government website that explains how Medicare works and how to enroll or change plans. It also has the helpful Medicare Plan Finder tool that lets you find and compare Medicare Advantage plans, Part D drug plans, and Medigap policies.

1-800-MEDICARE (800-633-4227). It’s Medicare’s toll-free number where you can talk to a human to answer questions. A Medicareadvantage.com article on this says that the fastest way to get through the toll-free phone number tree to get help is to say “Coverage and Benefits” or press 5 on your phone’s keypad. phone

The government is free Medicare and you 2024 manual. You can read online or receive a copy by mail. This guide is written in plain English and has a useful index.

State SHIP programs. SHIPs (full name: State Health Insurance Assistance Programs) offer free, unbiased telephone help about Medicare from state government experts.

Medicare Agents and Agents. They sell Medicare Advantage plans, Part D prescription drug plans and Medigap policies and are paid by insurers.

Medicare books and websites. Three useful books are Medicare for you by Diane Omdahl, Get what’s yours for Medicare by Philip Moeller and It’s not that complicated by Ari Parker. Websites worth checking out are the Chapter’s, which has a free Medicare Decision Sheet you can download) and Hello Medicare; both sites also sell Medicare policies.