Medicare’s annual open-enrollment season is here and millions of beneficiaries — prompted by a massive advertising campaign and aided by a detailed federal website — will choose a private Medicare Advantage plan.
But those who have instead opted for traditional Medicare face a critical decision about private insurance. Too often the import of that choice is not well communicated.
If beneficiaries decide to use traditional Medicare when they first join the program, they can pick a private supplemental plan — a Medigap plan — to help cover Medicare’s sizable deductibles and copayments for hospital stays, physician visits and other services.
But many people don’t realize that, in most states, beneficiaries have guaranteed access to a Medigap plan for only six months after they enroll in Medicare Part B — either at age 65 or when they leave private health insurance and join Part B.
While the Medicare.gov website offers a guide to these Medigap plans — labeled A through N — it’s a complicated decision because each plan provides different kinds of coverage — for 10 categories of benefits. Then there are the variants with high deductibles and limited provider networks. Premiums vary sharply, of course. And because seniors enroll in these plans throughout the year as they reach Medicare eligibility, there is far less publicity about the options.
As long as a beneficiary pays the premiums, they cannot be disenrolled from a Medigap plan.
For many who opted at some point for Medicare Advantage but decide later to move to traditional Medicare, getting a Medigap policy may be extremely difficult or impossible.
Lots of people making their plan choice this season may have missed their narrow window for Medigap enrollment. That means they may be stuck in Medicare Advantage or their current Medigap plan.
Ken Singer, 68, of Bridgewater, New Jersey, who retired from an investment management firm, didn’t know about the limited opportunity to sign up for a Medigap policy. “Nobody told me that,” he said. “I did a lot of reading about Medigap, but I found it kind of confusing.” He wants a policy because he’s leaving his wife’s employer-based health plan.
“Not that many people aging into Medicare at 65 fully understand that moment may be their only opportunity to opt into Medigap,” said Brian Connell, executive federal affairs director at the Leukemia and Lymphoma Society. “If you miss that short window, you’re left without protection from high out-of-pocket costs.”