Deciphering the ABCs of Medicare open enrollment

Medicare is just mind-boggling.

There are so many complex rules for the program that provides health insurance for Americans 65 and older.

"You need to be a Wharton-educated MBA and an MD to figure out the alphabet soup that is our health care insurance maze," one reader wrote.

Another said: "This whole subject makes my head hurt, and it's so tricky and complicated I feel certain that I will make the wrong decision in the end anyway."

These comments followed a recent column reminding folks about open enrollment – the season we make health care choices for the coming year. For Medicare, which also covers younger people with disabilities or individuals with end-stage renal disease, sign-ups begin Oct. 15 and end Dec. 7.

With so many choices to make, it's understandable that you may get overwhelmed.

"The typical response is people look at it and they think, 'Oh my goodness, I just don't want to deal with it,'" said Louise Norris, health policy analyst for HealthInsurance.org and MedicareResources.org.

It's all very daunting, but here are some basic things you should know about Medicare as we head into the open enrollment period.

Know the Medicare alphabet

There are so many parts to Medicare, which covers over 66 million Americans.

Part A is hospital insurance. You usually don't pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working for a certain amount of time.

Part B is medical insurance.

Part C is Medicare Advantage. It's offered by private companies approved by Medicare. These companies use managed care models, so they can be HMOs, PPOs, etc.

Part D is prescription drug coverage, providing price breaks for more than 51 million Americans.

Medicare has an online tool that makes it easier to comparison-shop. Log into Medicare.gov and select the link for "Find health & drug plans."

You can get guidance from Medicare by calling 1-800-633-4227. TTY users can call 1-877-486-2048.

If you find that you can't figure out what's best for you, get some help, Norris said.

"Reach out to somebody who can help you – a broker, a navigator, an enrollment counselor," she said. " The advantage of using those folks is this is just another day in the office. They know how it all works."

And don't wait to seek guidance.

"If you want help, now is really a good time to be lining up an appointment with someone who can walk you through it all," Norris said.

Don't believe the hype of Medicare Advantage commercials

Medicare Advantage enrollment is projected to increase from 31.6 million in 2023 to 33.8 million in 2024, according to the Centers for Medicare and Medicaid Services. That would represent about 50 percent of all Medicare enrollees, compared with approximately 48 percent for 2023.

This time of year, commercials for Medicare Advantage plans are ubiquitous.

"People love the fact that these plans have dental and vision because you don't get that with original Medicare," Norris said. "They oftentimes have coverage for hearing aids, which is another thing that is expensive and people don't get with the original Medicare."

But be skeptical about lofty promises.

"When I first enrolled in Medicare, I selected a Medicare Advantage plan because it seemed less expensive than traditional Medicare," Richard Timmins of Freeland, Wash., said in an email. "It was only when I needed care that I encountered the disadvantages of Medicare Advantage, limited networks, requirements for prior approval for almost everything, subsequent delays and denials, and denied payments."

Here's something many people don't realize until it's too late: You can switch from Medicare Advantage back to original Medicare during open enrollment or the Medicare Advantage open enrollment window, Norris said.

But – and this is key – if you've been enrolled in Medicare Advantage for more than a year, it's important to understand that you may not have guaranteed-issue access to a Medigap (Medicare Supplement) plan. That means your Medigap eligibility and premium will depend on your medical history.

Norris pointed out that Medigap insurers are not required to sell you a policy after your initial enrollment window or trial right window is over if you don't meet the medical underwriting requirements or if you have a preexisting condition.

"I'm trapped," Timmins said. "Enrollment isn't very open to me."

Original Medicare coverage is not enough

Many enrollees find they need extra insurance, so they sign up for a Medicare Supplement Insurance, or Medigap.

Medigap, which is purchased from a private health insurance company, helps cover out-of-pocket expenses such as co-payments, coinsurance and deductibles.

There are 10 types of Medigap plans, which are identified by letters A to D, F, G, and K through N. And to make things even more complicated, Plans C and F aren't available if you became eligible for Medicare on or after Jan. 1, 2020.

Drug coverage change for 2024

Thanks to the Inflation Reduction Act, starting in January, if you have Medicare Part D and your drug costs are high enough to reach the catastrophic coverage phase, you don't have to pay a co-payment or coinsurance once you reach that catastrophic coverage level.

Your Medicare drug plan can't charge you more than $35 for a one-month supply of each insulin product Part D covers, and you don't have to pay a deductible for it. This change took effect in 2023 and will continue to help beneficiaries who use insulin going forward.

Don't miss the deadline to sign up for Medicare Part B

If you missed your Part B enrollment window, which runs from the three months before the month of your 65th birthday through the three months after the month of your 65th birthday, you will face a late enrollment penalty once you do sign up.

The penalty equals 10 percent of the standard monthly premium for each 12-month period that you delayed enrollment.

High-income individuals and couples get hit with a surcharge

The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, compared with $164.90 in 2023.

If your modified adjusted gross income on your federal tax return from two years ago is above a certain amount, you'll pay the standard premium amount and what's called an income-related monthly adjustment amount (IRMAA).

For 2023, the threshold for IRMAA was $97,000 for a single individual and $194,000 for beneficiaries filing joint tax returns.

Don't miss the deadline to sign up for Medicare Part D

If you do not sign up for Part D when you become eligible for Medicare Part A and/or Part B and you didn't have prescription drug coverage that met Medicare's minimum standard, you may have to pay a late enrollment penalty.

You might not be taking prescription drugs now, but consider signing up for a Medicare drug plan or a Medicare Advantage plan with drug coverage to avoid a penalty later.

There's financial help if you need it

Low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs. You may qualify for help paying premiums, deductibles, coinsurance and co-payments. Go to medicare.gov/medicare-savings-programs for more details.

The Low Income Subsidy program, also called Extra Help, assists people with limited incomes and financial resources to pay for their prescriptions. For more information, go to medicare.gov/extrahelp.

Call Michelle Singletary at 1-800-Ask-Post. Readers can also write to Michelle Singletary c/o The Washington Post, 1301 K St. NW, Washington, DC 20071. Her email address is michelle.singletary @washpost.com. Follow her on X (@SingletaryM) or Facebook (facebook.com/MichelleSingletary).