Avoiding the Medicare enrollment deadline can be costly

But then something caught her eye: When she went to her doctor last month, she learned that the doctor and the hospital where she works won’t accept her insurance next year.

Faced with either finding a new doctor or finding a new plan, Du Bois said the decision was easy. “I stay with her because she knows everything about me,” she said of her doctor, whom she has seen for more than a decade.

Du Bois isn’t the only one heard when ads for the open enrollment deadline flood the airwaves each year — even though there may be good reasons to shop around. But sifting through the offers has become such an ordeal that few people want to repeat it. Avoidance is so rampant that only 10% of beneficiaries switched Medicare Advantage plans in 2019.

Once open enrollment ends, there are limited options for a do-over. People in Medicare Advantage plans can switch to another Advantage plan or return to their original, government-run Medicare plan from January through March. And the Centers for Medicare & Medicaid Services has expanded the criteria for granting a “special enrollment period” to make changes to drug or Advantage plans at any time.

But most seniors will generally allow their existing policy to auto-renew, whether they like it or not.

However, keeping her doctor wasn’t Du Bois’ only reason for changing plans. With the help of Senior PharmAssist, a Durham nonprofit that counsels seniors about Medicare, she found a Humana Medicare Advantage plan that would not only be accepted by her providers, but would also cover her drugs — saving her more than $14,000 a year, said Gina Upchurch, the group’s executive director.

Senior PharmAssist is one of the federally funded State Health Insurance Assistance Programs, known as SHIPs, available nationwide to provide impartial assistance during open enrollment and year-round to help beneficiaries appeal coverage denials and solve other problems.

“A lot of people are just overwhelmed by the calls, the ads, the sheer number of options, and this ‘choice overload’ contributes to decision-making paralysis,” Upchurch said. Seniors in Durham have as many as 74 Advantage plans and 20 drug-only plans to choose from, he said.

Upchurch said major insurers like the way the system works now, with few customers inclined to explore other plans. “They call it ‘stickiness,'” he said. “If we had fewer and clear choices – an apple, an orange, grape or banana – most people would reconsider the choices.”

In Washington state, a woman switched from a plan she’s had for more than a decade to one that will cover all her drugs and next year will save about $7,240, according to Tim Smolen, state SHIP director, Statewide Health Insurance Benefits Consultants.

In Northern California, another woman switched drug plans for the first time since 2012, and her current $86 premium will plummet to 40 cents a month next year, an annual savings of about $1,000, said Pam Smith, a local director of California SHIP. called the Health Insurance Counseling & Advocacy Program.

And in Ohio, a woman sought help after learning her monthly co-pay for the blood thinner Eliquis would increase from $102 to $2,173 next year. A consultant with Ohio’s SHIP found another plan that will cover all of her drugs for the year and cost her just $1,760. If she stayed with her current plan, she would pay an extra $24,852 for all her drugs next year, said Chris Rigg, who runs that state’s program.

In some cases, CMS tries to convince beneficiaries to switch. Since 2012, it has sent letters each year to thousands of beneficiaries in poor-performing Advantage and drug plans, encouraging them to consider other options. These are plans that have received fewer than three out of five stars over three years from CMS.

“You may want to compare your plan to other plans available in your area and decide if it’s still right for you,” the letter says.

CMS allows low-rated plans to continue operating. In an unusual move, officials recently determined that one plan had such a terrible track record that they will end its contract with government health plans next December.

CMS also contacts people about changing plans during open enrollment if they get a subsidy — called “extra help” — that pays for their drug plan’s monthly premium and some out-of-pocket costs. Because some premiums will be more expensive next year, CMS is warning beneficiaries that they could be in for a surprise: a monthly bill to cover the cost increases the subsidy it doesn’t cover.

But many beneficiaries don’t get such a push from the government to find out if there’s a better, less expensive plan that meets their needs and includes their health care providers or drugs.

That leaves many people with Medicare or Advantage drug plans to figure out any changes to their plans on their own while there’s still time to enroll in another. Insurers are required to notify members with an “annual change notice”, a leaflet that is often more than a dozen pages long. If they don’t get over it, they may find out in January that their premiums have gone up, the provider network has changed, or some drugs are no longer covered. If a drug plan is not offered the following year and the beneficiary does not select a new one, the insurer will select a plan of its choice without regard to cost or required drug coverage.

“Every year, our call volume skyrockets in January when people get invoices for this new premium,” said Reeg, the Ohio program director. At that point, Medicare Advantage members have until March 30 to switch to another plan or enroll in government-run Medicare. There is no similar grace period for people with stand-alone drug plans. “They’re locked into that plan for the calendar year.”

One cost-saving option is the government’s Medicare Savings Program, which helps low-income beneficiaries pay the monthly premium for Medicare Part B, which covers doctor visits and other outpatient services. The Biden administration’s subsidy eligibility changes announced in September would extend financial assistance to about 860,000 people — if they apply. In the past, only about half of those eligible applied.

Fixing a mistake after the open enrollment period ends on December 7 is easy for some people. People who get “extra help” to pay for drug plan premiums and those who have a subsidy to pay for Medicare Part B can switch drug plans every three months.

At any time, beneficiaries can switch to a Medicare Advantage plan that earns the top five-star rating from CMS, if one is available. “We were able to use these five-star plans as a safety net,” said Rigg, director of Ohio SHIP.

Other beneficiaries may be able to get a “special enrollment period” to change plans after open enrollment ends if they meet certain conditions. Local SHIP offices can help people make any of these changes when possible.

Reeg spends a lot of time trying to make sure that unwanted surprises—like a drug that isn’t covered—don’t happen in the first place. “What we want to do is proactively educate Medicare patients so they know they can go to the doctors and hospitals they want to go to next year,” he said.