What Medicare clients are asking during open enrollment

Craig Gussin isn’t only hearing from clients going into Medicare open enrollment season; he’s also hearing from his fellow Medicare agents as part of his involvement with several industry associations.

Gussin is president and CEO of Auerbach and Gussin in Carlsbad, Calif., in the San Diego metropolitan area.

“The comment I am hearing from agents is that this will be a tough Medicare season,” he told InsuranceNewsNet.

Medicare Advantage is a top issue for Medicare clients and their advisors, Gussin said.

He said one big issue in his geographic area is that one of the biggest hospitals in San Diego, along with two of the biggest physician networks, announced they no longer will participate in Medicare Advantage plans because of their reimbursement rates. This is leaving clients scrambling to find alternate coverage.

“One big question in all this is whether other hospitals around here will do the same,” he said. “Clients are worried. You have clients who are paying anywhere from zero to $20 a month for their Medicare Advantage premiums and now their doctors won’t accept their plans. So they have to either switch doctors or go to a supplement that costs them more money. And clients don’t like either of those options.”

Gussin said a big part of this year’s Medicare enrollment period will be educating clients about their options, costs and networks.

“The biggest takeaway for us will be education. It’s the education process and trying to fit that square peg into the round hole.”

Medicare Advantage clients worry about provider networks

Medicare Advantage plans are the top concern that Katie Diemer said her clients have going into the annual Medicare open enrollment season.

Diemer is an insurance specialist based in Reinbeck, Iowa.

She told InsuranceNewsNet her clients who are on Medicare have the same main concerns each year: their provider networks and their prescription drugs.

“They want to make sure that their doctors and hospitals will be in network with their Advantage plan, and my clients who have Medicare Supplement plans want to make sure their prescriptions will be affordable for the coming year.”

She said at least one carrier in her area still has a network that includes most of the major health care providers in the region, “so I have some peace of mind that we have one carrier we can recommend where our clients still can be in network.”

Diemer said that in Iowa, some Medicare plans have released sneak peeks of what the coming year will bring for their offerings.

“It seems like there will be some major changes coming for Advantage plans, mainly about networks that will change, and I also believe there probably will be some higher copays this year. I also believe we might see plans that are currently zero premium moving to a low premium.”

But even if Medicare Advantage plans move away from zero premiums, Diemer said she still believes Advantage plans offer her clients some economical options.

“There will still be some good Advantage plans for clients versus a Medicare Supplement because some of the supplements are really expensive and their drug plan is really expensive,” she said. “So even with a lower-premium Advantage plan, clients will still have costs; but overall, Advantage plans continue to be more cost-effective for them.”

Medicare Advantage plans aren’t going away

Deb Nelson is reassuring her Medicare Advantage clients that the plans they like are not going away.

Nelson is a licensed agent with Ark Insurance in Salt Lake City.

She told InsuranceNewsNet the biggest issue she is seeing in advance of Medicare open enrollment is client concerns about the future of Medicare Advantage.

“I hear from clients who tell me, ‘I love my Advantage plan, but I see so much on the news and on YouTube about how horrible these plans are and that they’re going away,’” she said. “And I tell them that Medicare Advantage plans are not going away.”

Nelson said she educates her clients about the pros and cons of both Medicare Advantage and Medicare Supplement plans.

“I have some clients who say they only want a supplement because they’ve heard bad things about Advantage plans. And I have other clients who say they love their Advantage plans. So clients are concerned about having options.”

Prescription drug costs are also top of mind for Nelson’s Medicare clients. The Inflation Reduction Act contains a number of Medicare prescription drug provisions aimed at lowering out-of-pocket costs beginning in 2025. Nelson said her clients are asking questions about what those provisions will mean for them.

“Anytime there’s a major change in Medicare and people see it in the news or they see advertisements that may or may not be accurate, they have questions,” she said. “It causes a little bit of confusion and concern.”

Nelson said her clients who are on Medicare Advantage plans “absolutely love them, because of the optional supplemental benefits and because the copays are so low.

“People like the predictability — they like knowing how much they are going to pay if they have to go to the hospital.”

She said her Medicare Supplement clients have faced some premium rate increases in recent years and are questioning whether they can afford to stay on their plans.

Another trend Nelson said she is seeing is with clients who are moving from Affordable Care Act marketplace plans to Medicare. “They feel Medicare is unaffordable to them,” she said. “They are seeing huge premium increases when going to Medicare Parts A and B.

“These clients were on subsidized plans, making the premiums low for them and, in some cases, for their spouse. Many were in the $60-$200 monthly premium range on the marketplace. They don’t qualify for Medicaid, and many are over the low-income subsidy limit as well but they don’t have a high income. They then have to pay Part B at $174.40 per month. It is a huge increase for them. They also lose the tax credit that they had with a marketplace plan. If they have a younger spouse on a marketplace plan, that increases as well.”

Nelson said she has seen clients paying $200 a month for themselves and a spouse for a marketplace plan and now have to pay $174 monthly for Part B while the spouse who is not old enough for Medicare now has to pay $400 monthly for health insurance.

“So in essence, they face a $374 monthly increase for turning 65 and going on Medicare.”

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 [email protected].