For senior citizens inundated with Medicare advertising (and those who help them)

Because of my own mother and my older sister's job, I have been aware of Medicare open enrollment happening at this time of year for a while now. 

It has only been working customer service for a Medicare supplement plan that has made me aware of the advertising onslaught that accompanies open enrollment. I have probably only avoided knowing because we DVR everything and fast forward commercials. There is tons of advertising via mail, radio, and television. 

I am aware of it now because I am taking the calls from members -- often ones who are very happy with their coverage -- that call concerned, worried that they are missing something or need to do something.

I talk to them, and to their children and grandchildren. I am not sales, so my role in that is generally things like confirming what coverage they have, whether they need to do anything to renew or if renewal will happen automatically (it will), and some questions about changes for the upcoming year.

However, sometimes we have conversations that are just about those concerns on whether they are covered enough or paying too much. Sometimes the best thing to do is to transfer to sales or to the group that covers the business end, but sometimes it just requires listening and being reassuring. 

I will now write to you in a very reassuring voice about Medicare and Medicare supplement plans.

One thing to remember is that the advertising is often geared toward people who do not have any supplemental coverage. 

This is not necessarily bad. My mother's quality of care improved a great deal when she got on to Medicare. She has always had a supplement though, first through Humana and then Blue Cross. Medicare itself still helped a lot. 

Why did she switch? Initially she had great coverage through Humana, and then things changed and the Blue Cross offering was better. 

Every year around October, Medicare releases their new plan information (what is covered and the prices) and formulary (coverage and pricing specifically for drugs). In response, Medicare supplement plans prepare their offerings for the next year. This leads into open enrollment and the advertising. 

Medicare is more likely to add coverage then take it away, but some changes may seem negative. For example, the Medicare Part B (medically necessary and prevention services) deductible is increasing by $30, from $203 to $233. Possibly not a big deal, but many seniors are on a fixed income.

That leads to another common question, as people hear ads referring to "Medicare Extra Help".

That is specifically for low-income seniors. In 2021 the limit for an individual was $19140, or $25,860 for a couple. 

That is a relatively easy question. The more complicated question is knowing whether your coverage is adequate.

That is a very personal question. There are people who specifically choose high-deductible supplement plans, because they would rather not pay a lot on premiums, but they still want to be prepared for something catastrophic happening. It's still a good idea to have some savings if you are going to pay $5000 out of pocket before coverage begins.

To figure out what is best for you, there are questions you can ask yourself. Financial issues to think about include...

• How much are you paying in premiums?
• How much are you paying in co-payments and coinsurance (toward deductible or otherwise)?
• How much are you paying for your prescriptions?

One of the nice things about being on Medicare is that you will get monthly notices tallying up your drug expenses and other expenses. I initially thought it was a ridiculous amount of paper, but I can understand now how it is helpful for people trying to figure out what they are paying.

The reason for that -- and it is another nice thing -- is that Medicare is a federal program and highly regulated. That means that there is a limit to how much any of the different offerings can diverge. It doesn't mean that some coverage won't work for you better than others, but there will be some common denominators.

The non-financial aspects to consider may be more about convenience versus hassle. If you need a specialist, is it easy to get into one? Remember, some coverage plans have their own providers, like Kaiser. That may be good for you, and it may not. 

Here is one example that is very individual: The plan I work with doesn't have an in or out of network as long as you see Medicare providers (meaning that they have agreed to charge Medicare set rates). For retirees who want to move across the country to be near children, or who want to be snowbirds and spend different months in different temperature states, that means more. For someone who will continue to live in the same place as before and not travel much, that would be less of a consideration.

Remember, open enrollment comes around every year. If you are not sure if you want to change, but think you might, perhaps taking a year to track everything and make notes will give you clarity during the next open enrollment.

Now, this is where I will be less reassuring, but it is important to think about. 

If your medical expenses are low due to good health, it can take just one accident or illness to change that. That can be hard to predict.

My real solution for that is universal health care, where we just treat people, and don't have multiple corporations in place to determine whether people can have health care or not. We still live under capitalism, and that is currently how I am employed. So, that's something to think about, and true for everyone to some extent, but some things can be more precarious for seniors.

Therefore, the other advice that I will always add is pray about things, and keep an ear out for inspiration as you go about your life. 

I hope that life will be long and healthy.