Medicare open enrollment is Oct. 15 to Dec. 7, giving people with Medicare a chance to change plans for the upcoming year. Although potential Medicare Advantage enrollees may be swayed by $0 premiums and extra perks like vision and dental coverage, there are more important features to explore when you’re choosing next year’s coverage. Here are some practices to avoid as you shop for Medicare Advantage this fall.

  1. THINKING MEDICARE ADVANTAGE IS MEDICARE If you’re considering Medicare Advantage, understand that it’s not the same thing as government-provided Medicare. It offers the same benefits, but Medicare Advantage is run by private health insurance companies and it operates differently. You can switch back to Original Medicare during each year’s open enrollment period, but you may not be able to qualify for an affordable Medicare Supplement Insurance, or Medigap, plan once you’re past the one-time Medigap open enrollment period. (Medigap helps with certain out-of-pocket costs not covered by Original Medicare.)
  2. ASSUMING YOUR DOCTORS ARE IN NETWORK Medicare Advantage plans operate within networks of medical providers, and you usually must see in-network doctors for covered care.

 “You want to double-check that your doctor is actually an approved provider in that network.”

  1. NOT CHECKING YOUR DRUG COVERAGE Like network providers, drug coverage can also change each year. Your drug plan might cover one of your medications differently in 2024, leaving you with more out-of-pocket costs than you expected.
  1. BUYING FOR THE DENTAL BENEFITS Medicare Advantage plans usually include benefits that aren’t part of Original Medicare, such as dental, vision, or hearing coverage. These extras may be appealing, but don’t let them steer your plan choice. If you pick (your plan) for a benefit that isn’t health insurance, you’re often picking wrong. And the dental benefit is pretty limited in all these plans — it’s a couple of cleanings and some bitewings.
  1. LOOKING AT THE PREMIUM ONLY The majority of Medicare Advantage enrollees are in plans with no premium, meaning you pay nothing each month for the plan. “And it’s not.” Research the rest of the plan’s costs before you sign up, including deductibles, copays, coinsurance and the out-of-pocket maximum, which is the most you might have to spend on covered care in a year. In 2023, the out-of-pocket max can be as high as $8,300 for in-network care.
  1. BUYING BECAUSE YOUR FRIEND HAS IT Focus on your own situation and find the plan that meets your needs.

Navigating the healthcare system is a treacherous business and one can only benefit from having a Certified Healthcare Case Manager educate and advocate for their right to have quality healthcare at affordable cost.

Get the Right Care; At the Right Time; In the Right Place; To Get the Right   Outcome!