Although Medicare open enrollment has ended, another important window is open until March 31 that allows people who are unhappy with their Medicare Advantage plans to switch to a different plan.
Medicare is the federal insurance plan for those age 65 and older and for some younger people with disabilities. Anyone covered by Medicare has access to the increasingly popular Medicare Advantage plans, which offer different options and benefits than standard Medicaid. There are 165 Advantage plans available in Georgia for 2024.
Advantage plans are offered by private insurance companies and are a profitable business for them, even though the plans are partly funded by the federal government.
The average monthly Medicare Advantage plan premium has risen to $16.50 this year, up from $14.70 in 2023, according to the Center for Medicare and Medicaid services (CMS).
In Georgia, CMS reports there are 1.9 million people enrolled in Medicare. Here’s how Medicare coverage options break down:
- Traditional Medicare (Parts A and B)
Traditional Medicare is also known as Medicare Parts A and B. Part A pays for hospital stays after a deductible has been met and possible copay. Part B pays 80% of doctor visits, with a deductible. These plans mostly do not pay for drugs at all.
The Part A policy is free for anyone who has paid into the Medicare system long enough. Premiums for Part B depend on the senior’s income and assets, but are often about $175 per month.
- Medicare drug coverage (Part D)
Medicare part D pays for drugs, covered by private insurance companies that contract with the government. So a patient can sign up for traditional Medicare parts A and B, and then also buy a Part D plan.
If they sign up as soon as they’re eligible, the patient may get pretty affordable drug coverage. But if they wait past their initial eligibility period — a certain time past their 65th birthday or past their retirement from an insured job — they’ll pay a penalty every year.
The amount of individual drug costs covered by Part D depends on the plan. Starting in 2025 there will be a new annual $2,000 cap on some out-of-pocket costs.
- Medicare Supplement Insurance (Also called Medigap)
Medigap coverage is a supplemental private plan to pay costs traditional Medicare doesn’t cover. Seniors can buy traditional Medicare Parts A and B, then add the Part D drug coverage, then add supplemental private Medigap plans to pay the 20% of medical bills that Medicare doesn’t cover, as well as other unmet costs. The supplemental plans might also cover vision and dental care.
If they sign up for Medigap as soon as they’re eligible for Medicare, the patient may get pretty affordable coverage. But if they wait and sign up later, the insurance company will assess the patient’s health needs and they could find themselves paying much larger prices for the coverage for the rest of their lives, or they may be denied a Medigap plan altogether.
- Medicare Advantage (also called Part C)
Medicare Advantage is run by commercial health insurance companies. It lumps Medicare and some additional coverage into one policy.
Patients must carefully evaluate what they might have to pay out-of-pocket, and what services the plan offers. Ask if the plan covers hearing, vision, dental and drugs.
Importantly, the plans have limited networks of doctors they’ll cover. Check to see which doctors are in the plan’s network.
These plans also may offer “flexible benefits,” which might just be vision and dental, or might be something like a flex card for groceries or a bonus in Social Security payments. Crucially, these extras may only be available to certain types of patients, and it’s important for buyers to check if they qualify.
To get specific advice, here are some unbiased sources:
- The State Health Insurance Assistance Program, or SHIP. Georgia SHIP is at 1-866-552-4464, option 4. They are open year-around, 8 a.m. to 5 p.m. Monday-Friday.
- 1-800-Medicare. To navigate the automated call system: Medicare Advantage is “Part C.” If you don’t have a Medicare number to input, saying “Operator” will get you put on hold to speak to a representative. The phone line is open year-around, 24 hours a day, except major holidays, according to a representative.
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