Medicare Season is the Time to Take a Look at all Health Needs

Posted on October 30, 2019

There’s the onslaught of TV commercials promising zero premiums, the insurance company reps asking for “a moment of your time” at the neighborhood pharmacy, and the offers of free breakfast at a local diner if you’ll listen to a plan presentation.

In autumn, the Medicare marketing pitches can seem to outnumber the falling leaves.

Whether you’re enrolling in Medicare for the first time or a longtime beneficiary considering a switch to a new plan, all the experts give the same advice: Get some expert advice.

Changes to the Medicare enrollment process this year add even more weight to that warning. The federal government revised its on-line system – called Medicare Plan Finder – and even experienced insurance counselors and independent brokers have been finding it difficult to navigate. Advocates for older adults are also sounding alarms about new guidelines from the Centers for Medicare and Medicaid Services (CMS) that they contend have weakened consumer protections against aggressive marketing tactics.

“There are so many intricacies to these Medicare plans, and they can change every year,” said Sheila Brogan, a social worker who helps counsel people on their options. “It’s important to look the plans over carefully so you don’t end up with any surprises.”

Social worker Sheila Brogan explaining prescription plan options at educational event at the Ridgewood Library

The annual Medicare Open Enrollment period, which started Oct. 15 and runs through Dec. 7, is a chance for people over 65 to try to match their anticipated medical needs with the insurance coverage they’ll pay for in 2020.

It’s always a confusing process, with an alphabet soup of options – Medicare has Part A, which covers hospitalization costs, Part B which covers roughly 80 percent of outpatient care costs, and Part D, which offers prescription drug benefits. Opting to choose coverage from those three parts is what’s considered the “traditional Medicare” option. Choosing traditional Medicare also involves making some choices – selecting between the 28 standalone prescription drug plans being offered by 11 companies in New Jersey in 2020 and deciding whether to also purchase a supplemental Medigap plan to pay for the out-of-pockets costs from Part A and Part B. There is also a reduced number of Medigap plan options this year.

Part C plans combine inpatient, outpatient and drug coverage into HM0- or PP0-style plans called Medicare Advantage. In New Jersey, eight different insurers are offering dozens of Medicare Advantage plan options, many of which offer low premiums and minimal dental and vision plans in exchange for older adults agreeing to be treated within a narrow network of doctors, hospitals and health care providers.

Older adults need to be aware, however, that if they choose a Medicare Advantage plan and are later unhappy with their choice they might end up having to pay more than what they had been for a Medigap plan, Brogan advises.

SHIP offices hold informational events during Medicare Open Enrollment

SHIP offices host informational events throughout Medicare Open Enrollment Season[/caption]Every county in New Jersey has a State Health Insurance Assistance Program (SHIP) office, whose employees and trained volunteers conduct informational seminars about the new year’s plan offerings and also offer one-on-one counseling.

Brogan, who is also co-chairwoman of Age Friendly Ridgewood, said it’s crucial for older adults to compare both price and coverage differences from year to year, and to also check if their preferred doctors and hospitals and prescribed drugs are included in the policy they select.

“I always tell people that even if you have liked the plan you have, you still need to look at it again each year and review whether the coverage is the same,” Brogan said.

This year, advocates are worried that the online system, which was re-launched in August and has already needed a number of fixes, is too complicated for many older adults to do side-by-side comparisons of their current coverage with the 2020 version.

Older adults listening to an educational presentation about Medicare options

One major change is that users need to create an on-line account to access the new plan information and must then update all their prescription and provider information from previous years. The process is cumbersome, prompting some county SHIP offices to circulate step-by-step instructions, but advocates still worry that counseling offices this year may be strained by many more requests for enrollment help.

Four national advocacy groups – the National Council on Aging, Justice in Aging, the Medicare Rights Center and the Center for Medicare Advocacy – wrote a letter of complaint to CMS administrators in August, saying the too-quick roll-out of the revised on-line platform combined with new CMS marketing guidelines will leave older adults vulnerable to making ill-informed choices. Advocates say those new guidelines don’t have enough protections for non-English speakers and have blurred the lines between “marketing events” where companies try to steer people to their plans, and “educational events” intended to explain the different options.

Beyond those concerns about the current year’s enrollment process, the process of picking the right Medicare option each year often reveals older adults’ other unmet social and financial needs, said Robert N. Frank, whose independent insurance agency, Absolute Insurance Management, is based in Lodi.

Independent brokers such as Frank do not work specifically for one Medicare insurance provider, and their commissions are paid by the companies, not the older adults. In addition to trying to help older adults select the plan that best meets their medical needs, Frank said he also surveys his clients about their other needs and helps them determine whether they are eligible to receive free or low-cost prescriptions from pharmaceutical companies offering such assistance or from the state’s Pharmaceutical Assistance to the Aged and Disabled (PAAD) and Senior Gold programs.

“One-third of the folks in Bergen County should be on PAAD and Senior Gold and don’t know it,” Frank said.
By not being aware of other assistance they qualify for, older adults could choose a more expensive Medicare plan that they will then struggle to afford, he said.

Frank laments that New Jersey insurers opted this year not to offer the “value-based insurance design” model plans being offered in a few other states. Such plans evaluate the other social determinants of a person’s health and design coverage around specific needs, such as by paying for telehealth management for people with chronic diseases or paying for grab bars or other home renovations for someone with a disability.

Some New Jersey insurers have begun adding some additional services to their Medicare Advantage plans, such as paying for transportation to doctor visits, Meals on Wheels deliveries or discounted memberships to a gym. But many older adults in New Jersey aren’t aware of such plan features, and there isn’t a groundswell of advocacy pushing insurers to embrace a more alternative and all-encompassing approach to providing health insurance, Frank said.

“People tend to focus only on whether their doctors and drugs are covered by a Medicare plan,” Frank said. “Really what we need is to be taking a bigger-picture look at all of their health and social needs.”

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