Commentary

With Medicare open enrollment ending this week, important things to keep in mind | Ray E. Landis

It’s important for consumers to make the right choice. The government isn’t helping

December 5, 2021 6:30 am

Protesters supporting “Medicare for All” hold a rally outside PhRMA headquarters April 29, 2019 in Washington, DC. | Win McNamee/Getty Images

If you have been watching any commercial television over the past few weeks you may notice the mix of advertisements has changed.

It has been hard to ignore the reminders that open enrollment for Medicare beneficiaries ends on December 7. These ads promise savings and additional services for individuals but fail to mention the complications and potential risks involved in making changes – let alone the potential for fraud as scammers work to take advantage of older Americans.

This comes in an environment where Medicare beneficiaries have learned the cost of their standard monthly premiums will jump by $21.60 in 2022. Although this will be more than offset by a 5.9% Social Security cost-of-living increase, the premium hike may result in more people questioning their current Medicare coverage.

Medicare was created as a health insurance program for Americans over the age of 65, but those opposed to a government-sponsored insurance program for older Americans forced the architects of Medicare to design a system that only covers 80% of health care costs with each beneficiary responsible for the remaining 20%.

This opened the door for private insurance companies to get involved in Medicare. Initially they sold Medicare supplemental insurance policies to help beneficiaries cover their 20% of health care costs. But as Medicare improved the health and longevity of older Americans, the health care needs of this population changed.

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Prescription drugs began to play a larger role in treating medical conditions. Congress added a prescription drug plan to Medicare but chose to have it offered by private insurers.

The bonanza for these insurers, however, came through adjustments to reimbursements for an overlooked provision of Medicare, commonly known as Medicare Advantage, which allowed them to assume responsibility for covering beneficiaries’ health care costs, a situation I discussed in more detail earlier this year.

The end result is not only the danger to the future financial health of Medicare, but the creation of a very confusing and pressure-filled environment for Medicare beneficiaries.

The television commercials are the first line of attack. These advertisements come in all shapes and sizes and are often featured during local news coverage. The larger health care systems in Pennsylvania – think UPMC, Penn Medicine, Geisinger, Penn State Health, Highmark – fill the airwaves with scenes of bliss for older Pennsylvanians.

The soothing voice-over urges viewers to call the toll-free number prominently displayed on the screen, where “enrollment professionals” who are working 24-7 will switch your coverage while you are on the phone with them.

Meanwhile there is another approach, usually offered by smaller insurers running advertisements during syndicated programming.

This appeal skips all the feel-good scenes and instrumental soundtracks and gets straight to the point – did you know you are entitled to health care benefits you may not be receiving? The announcer rattles off coverage of hearing aids, medical equipment, eye care, and gym memberships before telling beneficiaries they must call this number now.

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These are the enrollment pushes the general public is exposed to. But Medicare beneficiaries are subject to another line of attack through the U.S. Postal Service.

Over-sized postcards and letters fill mailboxes during the late fall urging individuals to switch their plans before it is too late. Many of these mailings are somewhat threatening, such as those with the bold word WARNING! on the cover.

Open enrollment has another consequence beyond annoying advertisements and mailings, however. It is looked at by scammers as open season on seniors. The quest to obtain Social Security and Medicare identification numbers is never-ending for these criminals and open enrollment is another opportunity to trick beneficiaries into revealing that information.

Legitimate insurers cannot legally call individuals about open enrollment unless the beneficiary has requested a call, but scammers make these calls in hopes of convincing a few people to reveal their private information, which can provide access to credit cards and bank accounts.

The good news in all this confusion is there are resources to help individuals make logical choices in open enrollment. The Pennsylvania Department of Aging offers free, objective health benefits counseling through Pennsylvania Medicare Education and Decision Insight – or PA MEDI, a service offered through the 52 Area Agencies on Aging. Medicare’s website  has a wealth of information useful in evaluating options.

But the bad news is this process continues to become more confusing and many older Pennsylvanians do not recognize making the wrong choice in open enrollment can result in loss of access to the physicians of their choice and could result in increased co-pays or deductibles.

Our elected officials have chosen to make it that way in order to placate those who profit from the confusion.

The worse news is these efforts endanger the future financial stability of the Medicare program, a situation Congress will need to address sooner rather than later.

Medicare beneficiaries, not to mention the overall financial health of the system, would be helped if the program was simplified. But given the influence of the profiteers, I’m not holding my breath until this happens.

Ray E. Landis writes about the issues important to older Pennsylvanians. His work appears biweekly on the Capital-Star’s Commentary Page. Readers can follow him on Twitter @RELandis.

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