Ready for Medicare? What to know during open enrollment
It’s open enrollment season - the time when Medicare ads are nearly inescapable if you’re watching cable TV.
It’s also the time of year Stephanie Miller reminds Medicare eligible people in Northeastern Pennsylvania to compare all of the plans they’re seeing on TV.
“Medicare is not a one size fits all,” Miller said. “It’s really an individualized decision and you have to make sure that you’re making the best decision for yourself.”
Miller is senior program manager at the United Way of Lackawanna, Wayne and Pike County and the PA MEDI coordinator for Lackawanna County.
PA MEDI, or Pennsylvania Medicare Education and Decisioning, has a coordinator in every county. Miller runs New to Medicare classes, and during open enrollment, handles calls from people looking to compare plans.
She said while calling the 800 numbers shown on Medicare Advantage plan ads will get you information about the plan being advertised, PA MEDI can help compare all of the available Advantage and traditional plans.
Advantage vs. Traditional Medicare
Traditional Medicare is purchased through and administered by the U.S. Government. It consists of three parts, with a fourth, supplemental option.
Medicare Part A provides coverage for inpatient hospital services including skilled nursing facility care, home health care, hospice care and hospital stays.
If an individual already gets benefits from Social Security, they’ll be automatically enrolled in Part A and Part B effective the first day of the month they turn 65.
Medicare Part B works similarly to typical health insurance. It provides coverage for services from doctors like preventive care, diagnostic tests and other outpatient visits and services. If a Medicare-eligible person still has employer-funded insurance through themselves or their spouse, they can defer enrolling in Part B.
Finally, those enrolling in traditional Medicare can elect a Part D plan, which covers prescription drugs. This portion is voluntary, however if you do not enroll in a prescription drug plan when you are first eligible for Medicare, you can incur penalties.
Miller says prescription drug plans are what most people who are already enrolled in Medicare re-evaluate during open enrollment. Drug prices can change every year depending on a person’s plan, and for most people, drug costs become a deciding factor between plans.
“So sometimes, a 50 cent (premium) plan, while the premium is less expensive, could have higher costs on drugs,” she said. “The only way to really know that is to do a plan comparison, because you can’t assume where your drug is going to fall.”
Medicare Advantage plans combine parts A, B and D. They are purchased from and administered by an insurance company and have their own networks of providers.
There are no national Medicare Advantage plans, but the plans must follow Medicare’s national rules regarding what is covered. These plans may have premiums and a deductible for both medical and prescription coverage.
Miller said most callers need help differentiating between Medicare Advantage and Traditional Medicare. PA MEDI is able to consult callers on both types of plans and review the available options from Advantage providers.
“A lot of people don’t know the difference between original Medicare with a Medigap versus getting an advantage plan,” she said.
Medigap is only available to people who are not enrolled in a Medicare Advantage plan. It can cover some of the costs that Parts A and B of Traditional Medicare do not such as copays. Medigap plans do have a premium cost.
Miller says open enrollment is a chance for everyone enrolled in Medicare to evaluate their current plans and costs. Medicare costs do change every year, and she will be going over those changes in her consultation calls.
“We’ll go over a prescription drug comparison with beneficiaries to look at what makes sense for them,” she said. “We’re not here to tell them what to do, what we’re here to do is educate them on their options so that they can make the best election for themselves.”
Miller said there are 21 separate Medicare drug plans available in 2024.
Open enrollment started on Oct. 15 and runs until Dec. 7. Last year, Miller said she and other PA MEDI volunteers for Lackawanna County took 300 consultations. Before open enrollment started this year, she had 100 appointments booked already.
PA MEDI is part of a national network of State Health Insurance Assistance Programs and run by the state Department of Aging.
Miller said they are meant to be a more accessible contact for any Medicare questions - Medicare's main number can often have long hold times for callers.
“If they have questions, they can contact us. They can also contact Medicare,” she said. “But to clear the lag times, they will get kicked back.”
According to the Department of Aging, PA MEDI volunteers can also help identify financial savings programs that Medicare beneficiaries may be eligible for.
More information on PA MEDI is available at aging.pa.gov.