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 number of TV ads for private insurers’ Medicare Advantage plans and mailboxes to enroll in them and Medicare Part D prescription drug plans. So you might think that people 65 and older would be especially harsh on all things Medicare.

Wrong.

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

For example, in a 2013 MedicareAdvantage.com survey of people ages 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 each time confusion about Medicare has surfaced.

Medicare confusion. “surprising and disturbing”

“It’s surprising and disturbing in equal measure,” said Christian Worstell, who conducted the latest 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, research it, and write about it every day.”

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

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

When Medicare beneficiaries or people who are about to enroll in Medicare don’t understand how it works, they can pay more for their health care than they need to and miss out on coverage they should be able to afford.

In fact, a survey by Retirement Living found that 51% of Medicare Advantage beneficiaries said their confusion led to unexpected bills for non-covered services, and 46% said they were more out-of-pocket than expected. have costs.

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

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

Medicaremany moving parts

Others may disagree that Medicare isn’t that complicated. Consider:

The original Medicare Act and the rules that followed are huge. According to Parker’s own book. It is not so complicated. Three Medicare decisions to protect your health and moneyThe 1965 law creating Medicare was more than 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 plan to reporters, he botched it so badly that the White House press secretary had to force the media to retract his description.

Medicare is like a train running 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). Another is Medicare Advantage (Part C), which includes Original Medicare coverage with a limited network of doctors and hospitals. In 2024, there will be 3,959 Medicare Advantage plans nationwide; The average Medicare beneficiary will have access to 43, according to KFF, a health policy research and news organization.

You need to understand all parts of Medicare: A, B, C, and D. To get Part C or D, you should shop around among health insurers and compare costs and benefits. In 2024, there will be 709 stand-alone prescription drug plans for people with Original Medicare; the average beneficiary will have about 60 choices, KFF says.

Then there’s another insurance policy you can buy to help pay for the part that Parts A and B don’t. It is a Medicare supplement policy or Medigap and you should also shop around if you want it.

In addition, Medicare has five enrollment periods: Open Enrollment from October 15 to December 7; Pre-registration (three months after the month of birth three months before turning 65); eight months Special registration After you lose health insurance from your employer or your spouse and the two periods between January 1 and March 31:general registration, if you did not sign up for Medicare Part B during initial enrollment and do not qualify for Special Enrollment and Enrolling in Medicare Advantageif you are in a Medicare Advantage plan and want to switch to another plan or leave it and enroll in Original Medicare.

As Worstell says: “There are a lot of moving parts. ifs, ands, and buts. There are many 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 Medicare coverage only adds to the public’s insurance literacy problems.

What people don’t know about Medicare

So why are people confused or mistaken about Medicare eligibility? Here are six examples.

2. Doctor’s fees

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

3. Mental health benefits

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

4. Auxiliary devices

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

5. Plan Changes

In a Commonwealth Fund survey of people 65+, 54% weren’t 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 expenses

A 2023 KFF survey found that only 34% of people 65+ knew there was a federal law (the 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. “Nobody likes to sit down and sort through all these benefits and costs,” he adds.

Where to learn about Medicare?

There are quite a few places for Medicare, though beneficiaries rarely use many of them, according to MedicareAdvantage.com research.

Some of the best Medicare resources

Medicare.gov. This is the official government website that explains how Medicare works and how to enroll in or change 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-MEDICARE (800-633-4227) It’s Medicare’s toll-free number where you can talk to a person to get answers to questions. An article on Medicareadvantage.com says that the fastest way to get through this toll-free number tree for help is to say “Coverage and Benefits” or press 5 on your phone’s keypad.

The government is free Medicare & You 2024 Manual. You can read it online or get a copy by mail. This guide is written in plain English and has a helpful index.

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

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

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