5 common Medicare open enrollment mistakes

Millions of retirees are in the midst of Medicare open enrollment, which begins Oct. 15 to Dec. 7, but many find the process challenging. Some don’t understand the difference between Original Medicare and Medicare Advantage, many are overwhelmed by Medicare advertising, and only four in 10 people review their plan options each year, according to a July 2022 report from health care firm Sage Growth Partners.

This leads to missed Medicare open enrollment, including not making sure your providers are in-network for the next plan year and not comparing your Medicare Part D drug coverage to other available options.

Medicare Guide 2023: More guidelines and advice for Medicare beneficiaries

Here are some common Medicare enrollment mistakes:

1. DON’T LOOK AT YOUR 2023 DOCTORS

If you have a Medicare Advantage plan, you usually have to get medical care from doctors within that plan — and the plan’s network can change at any time. Before you decide to stick with your plan, make sure your preferred medical providers are still in the plan’s network in 2023.

This may require some action on your part, as websites and supplier directories are not always up to date.

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“I was at a client, and (the plan) said their doctor was out of network, and it took us calling the provider and looking for a different location on the network side,” said Evan Tunis, president of Florida Healthcare. Insurance. “The best thing I can advise is to call the doctor’s office and confirm with them.”

2. DO NOT COMPARE PRESCRIPTION MEDICATION SYSTEMS

Whether you have Original Medicare or Medicare Advantage, your drug coverage comes from a private insurance company, and your coverage may change each year. Your regular prescription drugs may cost more in 2023, or insurance may not cover them at all. (Some plans may cover it for a small fee.)

It pays to link your prescriptions to Medicare.gov to see what plans they recommend. Pro tip: When you log into your account on Medicare.gov, your medication history is already there.

“It makes it a lot easier for them to buy into the next year,” said Katy Votava, who holds a doctorate in health economics and nursing and is president and founder of Goodcare, a Medicare economics consulting firm. They don’t have to put everything line by line and milligram by milligram.

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3. YOU THINK ALL DOCTORS WILL TAKE YOUR PPO PLAN

A preferred provider organization, or PPO, plan, is a health plan that allows members to see out-of-network doctors, often at a higher price. Sometimes people think that because they have a Medicare Advantage PPO, they will be able to see any doctor they want. But providers don’t always take out-of-network coverage.

“Providers … can simply refuse someone where they work if they don’t want to charge for the program,” Tunis said.

Important point: Mayo Clinic in Florida is out-of-network with most Medicare Advantage plans and will not schedule appointments for members with out-of-network Medicare Advantage coverage.

For full provider choice, choosing Original Medicare with Medicare Supplement Insurance, or Medigap, is “a very smart solution,” Tunis said.

4. BEING SHOCKED BY STAR ADVERTISEMENTS

Medicare’s open enrollment season means plenty of Medicare ads, and Medicare Advantage plans have attractive offers such as no premiums and some coverage for hearing, dental and vision care.

But shopping for your health is probably more than just fringe benefits. “Most of the time, honestly … they don’t really involve the teeth,” Votava said. “Getting a hearing aid is also very rare, and it’s not a reason to change your plan, so be very careful.”

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Even more important, Votava says, is making sure the plan includes your doctors and prescriptions for next year.

5. WAITING A LONG TIME TO ASK FOR HELP

Medicare’s open enrollment ends on December 7, but you don’t want to wait until the last day – or the last week – to start your research. If you have questions, you can get help through programs like the County Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can give you free help with your Medicare options, but they get busy.

SHIP programs in some parts of the country book several weeks out. “If you need help, don’t wait,” said Votava.

You can find your local SHIP at shiphelp.org.

This article was provided to The Associated Press by personal finance site NerdWallet. Kate Ashford is a writer at NerdWallet. Email: [email protected]. Twitter: @kateashford.

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