New to Medicare? Make decisions on plan merits, not advertising

Signing up for Medicare is one of those personal benchmarks every senior American eventually passes — not unlike the first day of school, getting a driver’s license, going to the polls for the first time or other milestones when they were younger.

But this step in life requires some serious decisions about Medicare, all designed to keep you as healthy as possible for the rest of your life.

It’s especially an adventure during enrollment time. Television, social media and the mail are loaded with an avalanche of advertisements trying to nudge new and current members toward making the “right” choices with private companies.

But Tatiana Fassieux will tell you there are better ways than media advertising to base your Medicare decisions on during the enrollment period — this year it’s Oct. 15-Dec. 7 — whether or not you’re wishing to make changes to your current plan. Seniors who reach age 65 or have a life change due to disability can apply at any time during the year, not just the enrollment period.

Fassieux, with the nonprofit California Health Associates (CHA), notes that advertising using personalities or dangling extra benefits is how many insurance companies selling Medicare plans make their options known, especially targeting those who are already overwhelmed by the hundreds of medical choices available to them.

Medicare changes for 2022

Such advertising directs seniors to companies that may sell them plans that don’t match well to their individual needs, said Fassieux, an education and training specialist for CHA, the leading advocate for Medicare beneficiaries in California.

“All health plans must cover the basic services under Medicare, but many also offer the ‘bells and whistles’ you may not need,” she said. “A health club membership or extra transportation may be something enticing but there’s probably a cost for that.

“Sure, it’s all part of the free market ­— each company pitches their best product. Some people are savvy but unfortunately some aren’t.”

Linda Cardoza, director of the Health Insurance Counseling and Advocacy Program (HICAP) in Orange County, said she can tell when these ads appear. That’s when the calls suddenly increase to her nonprofit independent agency that assists Medicare enrollees.

“On late-night television, someone will hear a personality pitching some really special benefit,” said Cordoza.

“The ads direct them to a phone number, but the person they get is a broker whose job is to sell them their company’s services and not necessarily what they need.”

Following up with their local HICAP is the way to clarify just what those pitches mean and to weed out those services that are not needed or are too expensive, she said.

Decisions, decisions

Getting the best benefits is all about making good decisions based on unbiased information, Fassieux said.

And there’s plenty of that around. The government has mailed those who are eligible its annual “Medicare and You” handbook that answers most of the questions enrollees may have.

The book explains how Medicare Part A offers health care from any doctor or hospital in the nation which accepts Medicare, but in order to reduce deductibles and payments, most enrollees pay for the additional Medicare Advantage HMO or Medical Supplemental coverage plans, which are the subjects of these advertising campaigns.

Enrollees can find in the rear of the book a comprehensive list of Medicare Advantage plans available in their particular county, in addition to Medicare prescription Part D plans.

If a person wishes to be in regular (Original) Medicare, they need to also consider signing up for a Medicare Supplemental plan through a trusted insurance broker at the time they are first eligible for Medicare.

(Insurance brokers may be independent and offer policy options from a variety of companies or may only sell policies from one company and be paid on commissions from that company. In California, brokers or agents must be licensed. Go to insurance.ca.gov/0200-industry to check a license.)

The complexity of all these plans is often a shock for people who for years have only had to deal with an employer’s relatively simple health plans which change little each year.

“They are used to having only a few choices to make, but this is entirely different,” she said.

Oddly enough, one of the initial decisions for new enrollees is determining where they plan to spend their retirement years.

Southern California residents have plenty of Medicare programs and medical facilities to choose from in each county, but moving to that idyllic lakeside cabin or a small town far away poses a problem. Fifteen California counties (mostly in the north) have no Medicare Advantage plans available, and other rural places have very limited services.

Living in Butte County, north of Sacramento, Fassieux has only one company offering her Medicare Advantage plans.

She pointed out that those contemplating moving to a place like remote Lake Almanor, in Plumas County north of Lake Tahoe, would probably have to drive several hours to Sacramento to get most of the benefits from a Medicare Advantage plan.

“You have to find what’s available in your area and what is the cost,” she explained.

Another question is whether an enrollee should pay extra for the expanded coverage of Medicare Advantage plans or only get the basic inexpensive Part A and Part B plus optional Medicare supplemental coverage.

“After all, some people think, I am in perfect health and never ill, why do I need something like that?” she said. “We are all human and figure we’re going to live forever. We don’t want to think of our mortality.”

She explained that a Medicare enrollee with only minimum coverage suddenly can be faced with an unexpected prescription that costs $300 a month or have a stroke that will require paying significant costs beyond the limited coverage. They won’t be able to change their coverage until the next enrollment period.

“Planning for the future of your health is no different than financial planning. You have to do both to prepare for the future. And there’s no crystal ball to help you.”

But a prudent strategy is to explore the major plans listed in the “Medicare and You” book, contact the various companies to hear about their offerings and, when questions appear, contact your local HICAP office (800-434-0222) where an independent unbiased expert can give a fair appraisal of your situation.

Making decisions about Medicare is certainly not an impossible undertaking for an individual ­— tens of millions of seniors have already successfully enrolled and made changes in it over the years.