Medicare Open Enrollment Is Here: What Beneficiaries Need to Know

COMMENTARY

Medicare’s annual Open Enrollment Period is here. From now until December 7, 63 million seniors and those with certain disabilities can shop for and enroll in Medicare coverage that suits their needs.

There’s a lot for seniors to consider at Open Enrollment, and the choices can feel overwhelming. Research from Kaiser Family Foundation found that 71% of Medicare beneficiaries do not compare their options – often because the current enrollment process still makes it difficult for seniors to discern what their options are in the first place.

The basic choice: FFS Medicare or Medicare Advantage

A fundamental choice during Open Enrollment is between fee-for-service Medicare (sometimes called “Original Medicare”) or Medicare Advantage. One-in-five seniors are not aware of the differences between these coverage options, and nearly a third say they could use more information.

When seniors are unable to make informed coverage decisions, the consequences can be harmful.

For example, while there are valid reasons a senior may choose FFS Medicare, a 2019 report in Health Affairs found that 23% of the sickest FFS Medicare enrollees were unable to pay for basic necessities. Separate research released the same year by Kaiser Family Foundation found that the eldest FFS Medicare beneficiaries spend an average of $10,307 annually on out-of-pocket costs.

These seniors may have benefited from a Medicare Advantage plan, which is shown to have a 40% lower cost burden than FFS Medicare and protects beneficiaries with an annual limit on out-of-pocket expenses.

Medicare Advantage could be a solution for many during this Open Enrollment season, too. At Better Medicare Alliance, we work to raise awareness of this still lesser-known but highly popular coverage option.

When thinking about a Medicare Advantage plan, here are a few things to know:

For 2022: Medicare Advantage premiums fall, quality ratings rise

As each Open Enrollment period approaches, the Centers for Medicare & Medicaid Services will traditionally release information on Medicare Advantage premiums and Star Ratings – quality measures that the government uses to help beneficiaries look for the best available health plan.

As expected, the Biden administration unveiled this information in recent weeks and it was good news for seniors. Average Medicare Advantage monthly premiums fell another 10 percent for 2022 to $19 a month, the lowest average premiums in 15 years. As Medicare.gov explains, “Many Medicare Advantage Plans have a $0 premium.”

Likewise, the Biden administration reported that 90% of Medicare Advantage beneficiaries were enrolled in health plans that received four or five stars on the government’s five-star quality scale. These Star Ratings are based on a rigorous set of 38 unique measures that track criteria ranging from customer service, to care coordination, and even how well health plans do at getting beneficiaries to receive their flu vaccine.

While the administration explained that certain changes to Star Ratings were made to account for COVID-19, it was quick to add that “this also reflects improvements in … [health plan] scores on several measures.”

Medicare Advantage networks: what do they mean?

Another consideration for those weighing enrollment in Medicare Advantage is its use of provider networks. These are sometimes pitched as a tradeoff of enrollment in Medicare Advantage, but beneficiaries have increasingly favorable views.

Recent polling from Morning Consult found that 97% of seniors on Medicare Advantage are satisfied with their network of doctors, hospitals, and specialists, including 75% who are “very satisfied.”  

Provider networks in Medicare Advantage can also better facilitate care coordination – ensuring that a team of doctors are working together on your behalf, reducing occurrences of duplicative tests and services or conflicting information.

While provider networks are not used in FFS Medicare, this doesn’t necessarily guarantee access to a preferred physician. Nearly 10,000 doctors have opted out of FFS Medicare altogether.

Supplemental benefits in Medicare Advantage

Medicare Advantage provides additional benefits unavailable in FFS Medicare. For example, Kaiser Family Foundation reports that, for 2021, 98% of Medicare beneficiaries had access to at least one Medicare Advantage plan with vision, hearing, and dental coverage.

Another analysis found that, in the past year, 57% of Medicare Advantage plans offered some form of meal benefits while 46% provided transportation between doctor’s appointments.

CMS reports that “Medicare Advantage plans will continue to offer a wide range of supplemental benefits in 2022, including eyewear, hearing aids, both preventive and comprehensive dental benefits, access to meals (for a limited duration), over-the-counter items, fitness benefits and worldwide emergency/urgent coverage.”

You can change your mind

Medicare Advantage enjoys a high retention rate with only about 8% of beneficiaries voluntarily switching coverage in a given year (and sometimes this means switching to another Medicare Advantage plan).  Moreover, its 98% beneficiary satisfaction rate offers reassurance to many new enrollees.

Still, beneficiaries may ask: can I change my mind? Indeed, you can – and you don’t have to wait an entire year to do it. The government offers a special Medicare Advantage Open Enrollment Period from January 1 to March 31 each year. During this time, Medicare Advantage beneficiaries can switch to a different Medicare Advantage plan or change to enrollment in FFS Medicare.

This Open Enrollment season, encourage the seniors you know to learn about all available options and make an active decision that meets their unique needs. For many, Medicare Advantage may be the right choice.

Mary Beth Donahue is President and CEO of the Better Medicare Alliance, a nonprofit Medicare Advantage research and advocacy coalition. She served as Chief of Staff at the U.S. Department of Health and Human Services from 1998 to 2001.