Photo by Jennifer Uppendahl on Unsplash

• Share

PRINT

Here are some tips for choosing insurance and prescription drug coverage for the coming year during Medicare’s open enrollment period, which opens October 15 and closes December 7. 

Enrollment in Medicare Advantage plans continues to rise. “Medicare Advantage plans are growing in popularity because they are very good at communicating with consumers and offering benefits like dental, vision and hearing care that attract interest,” said Jenny Chumbley Hogue, an analyst for medicareresources.org. 

 “Ultimately, the choice is one that deserves careful consideration each year. A plan that appears attractive at first glance could end up costing you more down the road if it’s not the right plan for your needs. The devil is always in the details.” 

In 2022, 28.4 million Americans were enrolled in Medicare Advantage plans — 48% of all Medicare beneficiaries. That’s more than double the percentage enrolled in 2007, and is predicted to continue rising.  

During Medicare open enrollment, Medicare beneficiaries who are already enrolled have a handful of decisions regarding their coverage. Options include:  

• Switching from Original Medicare to Medicare Advantage, or vice versa.
• Switching from one Medicare Advantage plan to another.
• Switching from one Part D (that is, prescription drug) plan to another. 

“There are trade-offs depending on which option you choose,” said Chumbley Hogue.  

“Advantage plans tend to have a more limited healthcare provider network, and coverage for specific services may not be as robust as you can get with Original Medicare plus a supplemental (Medigap) policy to fill Medicare’s gaps. But Advantage plans also tend to be less expensive.  

“On the other hand, if you are enrolled in Original Medicare and have additional coverage through Medigap and stand-alone Part D drug coverage, that could end up saving you money in the long run if you develop a serious or chronic health condition.” 

Weighing pros and cons 

Medicareresources.org suggests consumers take into consideration several factors when deciding between Original Medicare and Medicare Advantage: 

• Provider network: Original Medicare has a broader provider network with nationwide coverage. Medicare Advantage plans each have their own network, which may be more limited in terms of providers and coverage area.  
• Premiums: The average total of premiums for Medicare Advantage (including the Part B premium that is also paid by Medicare Advantage enrollees) is less than the average total of premiums for Original Medicare plus Medigap and Part D drug coverage.
• Out-of-pocket costs: Original Medicare coupled with Medigap coverage may come at a higher monthly premium, but could result in little to no out-of-pocket exposure (other than the cost of medications, which are covered separately under Part D). 

With most Medicare Advantage plans, you’ll pay coinsurance and copays that could total as much as $8,300 in 2023 for services that would be covered under Original Medicare with Part A and B (plus the cost of medications). 

• Prescription drug costs: Most Medicare Advantage plans include Medicare Part D drug coverage, but if you’re considering an Advantage plan, you should check it to make sure. 

Each Medicare Advantage plan will also have its own preferred drug list, which determines how much you pay for your prescriptions.  

If you stick with Original Medicare, you will need to choose and pay for a stand-alone Part D plan if you need prescription drug coverage. These plans are offered by private-sector carriers, and the cost and benefits will vary from one plan to another. 

• Travel: If you plan to travel, keep in mind that Original Medicare doesn’t cover medical expenses incurred during foreign travel except for a few rare circumstances. 

(Medigap plans, which provide supplemental coverage for Original Medicare enrollees, provide some coverage of medical expenses for enrollees traveling internationally.)  

With Medicare Advantage, health coverage during domestic and foreign travel varies. Medicare Advantage plans offer nationwide emergency room coverage at any hospital that accepts Medicare. 

• Extra benefits: Medicare Advantage plans often include extra benefits — like dental, vision, hearing aids and gym memberships — that are not offered by Original Medicare (or typically covered by a Medigap plan).
• Special plans: People with certain health conditions or applicants with low incomes (e.g., eligible for Medicaid) may be eligible for special types of Medicare Advantage plans with additional benefits or cost savings.

Can you change your mind? 

Consumers should also consider their ability to change their Medicare coverage later on.  

“If the ability to easily switch back and forth among plans is important to you, a Medicare Advantage plan offers that flexibility,” Chumbley Hogue said.  

“On the other hand, your ability to switch from Medicare Advantage altogether (and enroll in or return to Original Medicare plus Medigap) could be hindered by your medical history. That’s because enrollees who have had Medicare Advantage coverage for more than a year” may be denied Medigap coverage for pre-existing conditions,” she said. 

[Ed. Note: The only time a Medicare beneficiary can be guaranteed a choice of any Medigap plan without regard to pre-existing conditions is during their initial enrollment period, which occurs around the time one turns 65, or if they qualify for a guaranteed issue right (for example, their Medicare Advantage plan stops offering coverage in their area.)]  

How to compare plans 

Evaluate your insurance and prescription drug coverage each year to ensure you have a plan that still meets your needs.  

“As with all private health insurance plans, offerings change from year to year, and from area to area,” Chumbley Hogue said. “Insurance carriers may enter or exit different markets. They may also adjust plan costs, their provider network, covered prescriptions or their covered benefits.” 

If you currently are enrolled in a Medicare Advantage plan, here’s how to evaluate your coverage during Medicare open enrollment: 

• Check whether your preferred providers are still in-network.
• Review whether your prescription drug costs change in the upcoming plan year, and always check multiple pharmacies to determine the right plan for you. 
• Consider all of the available Medicare Advantage plans — comparing premiums, provider networks and prescription drug costs. [You can do this at Medicare.gov/plan-compare.]

“You really need to pay close attention to the details when you’re assessing Medicare Advantage plans,” said Chumbley Hogue. “Read the fine print and reassess your plan each year to make sure you understand your plan costs and your plan benefits.” 

[The same holds true for those on Original Medicare, who may choose a new Part D prescription drug plan during Open Enrollment. Go to Medicare.gov and compare all your options.]   

For additional information about Medicare open enrollment, and assistance in making your choice, visit the websites mentioned above, call 1-800-MEDICARE, or contact your local SHIP (State Health Insurance Assistance Program).  

To reach SHIP in Montgomery County, call (301) 255-4250; Prince George’s County: (301) 265-8471; Washington, DC: (202) 994-6272; Arlington, VA: (703) 228-1700; Alexandria, VA: (703) 746-5999; Fairfax, VA: (703) 324-5851; Baltimore City: (410) 396-2273; Baltimore County: (410) 887-2059; Howard County: (410) 313-7392.  

Medicareresources.org is owned and operated by Healthinsurance.org, a corporate affiliate of a group of insurance agencies and marketers. The site provides an overview of the basics of Medicare coverage options, enrollment and eligibility; coverage FAQs; state-specific Medicare information; and a glossary of Medicare terms.