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Why is Medicare Annual Enrollment a Big Deal?

By Gail Glockhoff-Long
GolderCare Solutions
Benefits Advocate

If you turn on the TV you can’t miss the barrage of ads for Medicare Annual Enrollment October 15 – December 7 this year. Do I really need to review my plan yearly? What happens if I don’t review it?

Traditional Medicare has a set of rules that apply to everyone across the country on Medicare. The rules outline what is covered and when. You fall and break your leg. It is not covered by Medicare if you were at work and it is covered by the employer’s Worker’s Comp insurance, or if you fell at a business due to a defective carpet and the liability belongs to the business owner and their insurance.  But, if you fell and no one else is at fault, Medicare covers it.  Medicare has deductibles and co-pays but generally pays 80%. Everyone on traditional Medicare has the same basic coverage which remains consistent year after year.  Occasionally they may add a new coverage but you know what you can count on.

The gaps in Medicare coverage is where the Medicare Supplement (or ‘Medigap’) insurance steps in.  It is designed to cover the co-pays and deductibles that go with traditional Medicare. Med-Sups give you the options of a basic plan or a plan that includes foreign travel or a plan that is more expensive but covers everything or a plan that is less expensive but only kicks in after you have paid a high deductible.  You can pick the gap coverage that meets your specific lifestyle and needs.  By law, every plan of a specific letter has the same coverage as the same letter plan from every other company. Like traditional Medicare, this coverage remains constant with very little change from year to year.   

Part D drug plans are a wild card. What medications they cover at what tier level and what co-pay varies wildly from year to year. Your medications can also vary from year to year. Most people I know who took few medications at age 65 signed up for the least expensive drug plan. Now at age 70 they may have added expensive meds for blood pressure, diabetes, cholesterol, and others which were not covered well under that original drug plan. Every year it is important to review your Part D plan with your insurance expert to see how it is covering the medications you now take. A different plan may work better for your current needs.

Advantage Plans are the most important reason for annual enrollment and review. Basically Medicare gives a set amount of money per enrollee to an insurance company to cover the medical costs of that person. There are multiple companies across the country. The big company in this area is UnitedHealthcare This is managed care and each company decides how to use the per capita allotment. Most plans include coverage for drugs but not all. Some include coverage for eye glasses or dental or gym membership or offer money back. Because the company is reimbursed by Medicare, you often pay no premium for these plans but they do have co-pays. The important thing to keep in mind is that the company’s job is to manage your care costs while making as much profit as they can. They do this with trade-offs. They may offer gym membership that you will never use but to offset that cost, they may have higher co-pays for doctor visits.  They may include a dental coverage but the offset is higher per day co-pay for hospitalizations.  They may include an eye check-up and allotment for glasses but the drugs you take are now not covered or are in a high co-pay tier. They also have restrictions on what medical providers are in your “plan.”  The local hospitals are included, as is Iowa City but if you need to go to AD Anderson Cancer Center or Northwestern Medical, they are probably not covered as in-plan.  

The crazy part of Advantage Plans is the insurance company can change anything they want once a year. The provider list, medication tier schedule, co-pays and extra perks like dental can all change for the next year.  Your health could also have changed so you now need different specialists. Are they in the plan? Your only notice of changes is reading the big book they send you about updates for the next year.  As a result, the UnitedHealthcare plan that was perfect in 2023 may not be a good match for 2024 – or it could still be perfect. One of the trade-offs for a low or $0 premium is the uncertainty of what will be offered each year under that plan and the necessity to talk with your insurance expert every year during open enrollment.

For those on MediCAID, the state has assigned you to a managed care company to cover the Medicaid part of your medical costs. This plan is in addition to the coverage you already have under MediCARE. Medicare pays first, then your supplement if you have one, then the Medicaid plan. 

GolderCare has expertise in how Medicare coverage impacts our aging journey.  

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GolderCare Solutions is an independent advocacy group for seniors, the disabled and those that care for them. GolderCare has offices in Moline and Bettendorf. You can reach GolderCare at (309) 764-2273 or learn more at www.goldercare.com.