Medicare clients ask about prior authorizations, higher premiums

Editor's note: The following article is part of a series on what clients are asking their advisors prior to the Medicare open enrollment period.

Prior authorizations and higher premiums are two of the biggest issues that Dawn Freeland said her clients are concerned about going into the Medicare open enrollment period.

Freeland is owner of Freeland Insurance Solutions in Portage, Mich. She spoke with InsuranceNewsNet about the upcoming Medicare enrollment period which begins Oct. 5 and runs through Dec. 7.

She said her clients are having more issues with Medicare Advantage plans requiring prior authorizations.

“It’s a huge thing and it’s how a lot of carriers are getting around paying for some of these bigger ticket items,” she said. “They’re requiring more prior authorizations, which means they’re controlling what drugs people can and can’t take, what surgeries people can and can’t have. I don’t think that’s the right road to take, because you’re limiting people’s ability to receive care. I’m seeing people here in Michigan being required to have a ton of prior authorizations. I’m afraid it’s going to increase next year and will deter people from going into the advantage market.”

At the same time, she said, many of her clients can’t afford to move to a Medicare Supplement plan with Part D drug coverage.

“I think the price will go up across the board, no matter what,” she said. “People want to have that traditional Medicare plan, but I think we’ll see a lot of people jump ship to advantage plans for 2025 because they can’t afford the premiums.”

Freeland said she believes those who establish Medicare pricing and regulations are far removed from those who are trying to access health care and pay for it.

“They don’t see how it impacts people in the community the way I do,” she said. “It’s really hard to sit across from someone and hear them say they can barely afford food and they need their medication to live. I think it’s sad that our country has come to the point where people value money and politics over the people who spent their whole lives paying into the system.”

But she also realizes that health plans need to raise premiums in response to their own rising prices.

“If carriers keep getting all these costs put on them, then there’s only so much they can take before passing it on to the consumer,” she said. “I’ve already told my clients they may see higher copays.

Freeland said she views her job as educating her clients about Medicare so they understand what their choices are and what they are paying for.

Her biggest advice to consumers about Medicare? Talk to an agent about your concerns.

“Talk to a local agent, because we are a wealth of knowledge, and we really do want to help people.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.