Medicare confusion hurts your health and costs you money. Experts help explain what you need to know

Since his Medicare Open Enrollment season, you’ll likely see a slew of television commercials for private insurers’ Medicare Advantage plans and mailers to enroll in them and Medicare Part D Prescription Drug Plans. So, you might think that people 65 and older would be particularly attentive to all things Medicare.


In fact, several recent surveys show that most Medicare beneficiaries are quite confused about Medicare coverage and costs.

For example, in a Survey of 2,013 people ages 65 to 99, 65 percent of Medicare beneficiaries said the government’s health insurance program was confusing and difficult to understand. This is the third year that the site has conducted a similar survey and the confusion about Medicare is great each time.

Medicare confusion: “surprising and disturbing”

“It’s both surprising and disturbing,” says Christian Worstell, who led the recent investigation. “I write about Medicare as my full-time job and I recognize that it’s confusing. Imagine how confusing this is for someone who doesn’t read, research, and write about this topic every day.

In a Survey on retirement residences of 351 beneficiaries of private insurers’ Medicare Advantage Plans (the alternative to Original Medicare), only 44% say they understand their plan well. One in eight people misinterpreted some aspect of their plan after signing up.

But, Worstell says, “knowledge is power when it comes to getting the most out of your benefits and purchasing the right coverage for your needs.”

When Medicare beneficiaries or people about to enroll in Medicare don’t understand how it works, they may end up paying more for their health care than necessary and not getting the coverage offered to them.

In fact, Retirement Living’s survey found that 51% of Medicare Advantage beneficiaries said their confusion led to unexpected bills for uncovered services and 46% said they had higher out-of-pocket costs than foreseen.

Ari Parker, co-founder of the Medicare Advisory Service chapter, is also surprised to find how little older Americans know about Medicare.

“If they know where to turn for information, it’s not that difficult,” he says.

Health Insurancethere are many moving parts

Others may disagree that Medicare isn’t that complicated. Consider:

The original Medicare law and its resulting rules are enormous. According to Parker’s own book, It’s Not That Complicated: Medicare’s Three Decisions to Protect Your Health and Your Money, the 1965 law creating Medicare was more than 1,400 pages long, and tens of thousands of pages of rules and regulations have been added since then. Parker wrote that when President Lyndon Johnson tried to explain his new Medicare program to reporters, he misrepresented it so much that the White House press secretary had to convince the media to retract his description.

Medicare is like a train running on two tracks. One of them is Original Medicare, which includes Part A (hospitalization insurance) And Part B (doctor visits, home health care, medical equipment and preventive services). The other is Medicare Advantage (Part C), which includes coverage that Original Medicare does not provide with a limited network of doctors and hospitals. There will be 3,959 Medicare Advantage plans nationwide in 2024; the average Medicare beneficiary will have access to 43, according to health policy research and information organization KFF.

You must understand all parts of Medicare—A, B, VS And D. To get Part C or D, you need to shop around among health insurers and compare costs and benefits. There will be 709 stand-alone prescription drug plans for people with Original Medicare in 2024; the average beneficiary will have the choice between nearly 60, specifies KFF.

Then there is another insurance policy you can get to help pay for what Parts A and B don’t cover. This is a Medicare Supplement, or Medigap, policy, and you also have to shop around if you want.

Additionally, Medicare has five enrollment periods: Open Enrollment from October 15 to December 7; Initial registration (three months before your 65th birthday and three months after the month of your birthday); the eight months Special registration after losing your employer’s or spouse’s health insurance and the two periods from January 1 to March 31—General registration, if you did not enroll in Medicare Part B during initial enrollment and are not eligible for special enrollment and Enrolling in Medicare Advantageif you have a Medicare Advantage plan and want to switch to another or drop it and enroll in Original Medicare.

As Worstell says: “There are a lot of moving parts; if, and and but. There are many terms and exceptions. “Does Medicare cover this?” Well, yes, but only if the following 11 things are true.

Worstell notes that health insurance itself can be confusing and that the Medicare system only adds to problems with the public’s knowledge about insurance.

What people don’t know about Medicare

So what are people eligible for or receiving Medicare confused or wrong about? Here are six examples:

1. Franchises

A total of 49% of Medicare beneficiaries surveyed by believe that Medicare does not charge a deductible (what you pay out of pocket before coverage kicks in) for hospital care. That’s done.

The deductible for Part A will be $1,632 and the deductible for Part B will be $240. Part C deductibles vary depending on the Medicare Advantage plan. “I think you really want to know before you go to the hospital that you’re going to have to pay $1,600,” Worstell says.

2. Doctor’s fees

When current beneficiaries or people about to enroll in Medicare don’t understand how it works, they may end up paying more for their health care than necessary. This is called a “surcharge” and can represent up to an additional 15% of the doctor’s bill.

3. Mental Health Benefits

More than two-thirds (71%) don’t know that Medicare covers inpatient and mental health treatment. “It is disturbing to think how many people might need mental health treatment and are not seeking it because they think it will not be covered by Medicare and do not want to have to pay for it out of pocket” , says Worstell.

4. Assisted devices

Only 29% knew that Original Medicare generally covers walkers, walkers and wheelchairs. “I think most people don’t really associate equipment and appliances with insurance,” says Worstell.

5. Changes to the plan

In a investigation Among people 65 and older in the Commonwealth Fund, 54% did not know how difficult it was to switch from Medicare Advantage to traditional Medicare and get a Medigap policy. Another 21% didn’t even know it was an option.

6. Reimbursable expenses

A KFF 2023 investigation found that only 34% of people 65 and older knew that there is a federal law (Inflation Reduction Act of 2022) that limits out-of-pocket costs of prescription drugs for people with Medicare.

Learning the ins and outs of Medicare can be intimidating and “it’s not fun,” Worstell says. “No one likes to sit down and look at all these benefits and costs,” he adds.

Where to learn more about Medicare

There are many places to get Medicare, although beneficiaries rarely use many of them, according to the survey.

Some of the Best Medicare Resources This is the official government site that explains how Medicare works and how to sign up or change plans. It also has the utility Health Insurance Plan Search tool that lets you find and compare Medicare Advantage plans, Part D drug plans and Medigap policies.

1-800-MEDICATION (800-633-4227). This is Medicare’s toll-free number where you can speak to a human to get your questions answered. A article on this subject states that the quickest way to navigate that toll-free number’s phone tree for help is to say “Coverage & Benefits” or press 5 on the dialpad. your phone.

The government is free Medicare and you 2024 manual. You can read it online or receive a copy by mail. This guide is written in plain English and has a useful index.

National SHIP Programs. SHIPs (full name: State Health Insurance Assistance Programs) provide free, unbiased Medicare telephone assistance from state government experts.

Medicare Brokers and Agents. They sell Medicare Advantage plans, Part D prescription drug plans, and Medigap policies and get paid by insurers.

Medicare Books and Websites. Three useful books are Health insurance for you by Diane Omdahl, Get what’s yours for Medicare by Philip Moeller and It’s not that hard by Ari Parker. Websites worth checking out are those of Chapterwhich has free access Medicare Decision Worksheet you can download) and Hello Medicare; both sites also sell Medicare policies.

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