What to consider during government shutdown
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Open enrollment in Medicare began October 15; But in a notable difference for beneficiaries considering updating their health insurance plans, the federal government has been closed since October 1.
Medicare updates open enrollment This practice, which will last until December 7, will continue during the government shutdown, according to the Centers for Medicare and Medicaid Services.
Because the federal shutdown could impact timely access to information, Philip Moeller, author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs,” recommends delaying finalizing coverage decisions for 2026 until the government reopens.
“I strongly recommend people wait to decide on next year’s broadcast,” Moeller said.
Even a change made on the last day of open enrollment would be effective starting Jan. 1, Moeller said.
“There should be no rush to decide,” he said.
How does Medicare open enrollment work?
Now through December 7, Medicare beneficiaries will be able to make changes to their coverage. These options vary depending on your current enrollment — whether you have original Medicare, which usually includes Part A hospital coverage and Part B health insurance, or Medicare Advantage, which are private plans approved by Medicare.
During this time, beneficiaries can switch from original Medicare to Medicare Advantage or vice versa, change Medicare Advantage plans, or—provided they have original Medicare—find new Medicare Part D prescription coverage.
Shopping always pays off because you never know what you’re leaving on the table. Maybe your current plan will no longer offer you the best coverage at the lowest cost.
Juliette Cubanski
Deputy director of KFF’s program on Medicare policy
Medicare beneficiaries may tend to set it and forget it when it comes to their current plans. But according to Juliette Cubanski, deputy director of KFF’s Medicare policy program, it would be wise to consider how much coverage might change in the coming year, which could affect out-of-pocket costs, especially for preferred doctors or required medications.
Medicare beneficiaries’ out-of-pocket health care expenses recently averaged 39% of per capita Social Security income in 2022. KFF research to create.
“Open enrollment offers people the opportunity to evaluate the coverage they currently have and other options in their area and see if they can get a better deal,” Cubanski said. he said.
While some Medicare carriers are expanding in certain markets, others are pulling back or even leaving select areas, according to Moeller. “It’s especially important for people to do their homework this year,” he said.
Government shutdown may impact access to information
The federal government shutdown may not “dramatically” impact Medicare open enrollment, according to Cubanski.
Depending on their coverage options, people trying to contact 1-800-Medicare for help may experience some delays, Cubanski said.
Other sources, like Medicare’s, are still open for business Plan Finder Medicare Advantage or drug plans and Medigap carriers, the portal said.
I strongly recommend people wait to decide on next year’s release.
Philip Moeller
Author of “Take What’s Yours for Medicare”
But Moeller said the closure could make it difficult to get specific answers to questions about the information in the Plan Finder. He said staffing shortages could lead to delays in using the 800 Medicare number.
“Critical activities and updates related to Medicare Open Enrollment will continue during the government shutdown,” states the Medicare.gov website, which is managed by the Centers for Medicare and Medicaid Services. The agency did not return a request for further comment by press time on how the closure might affect open records.
Because of these potential information limitations, Moeller said he urges people to wait to make decisions about next year’s coverage.
Tradeoffs between Medicare original and Advantage
As Medicare beneficiaries consider whether to opt for original Medicare or private insurance through an Advantage plan, experts say it’s worth weighing the pros and cons.
But even though there is an advantage While the plan may offer dental benefits, for example, it’s important to understand exactly what that includes, he said. Does this include just one cleaning per year, or is the coverage more extensive, such as two cleanings per year and denture cleaning?
Medicare Advantage, of course, limits access to certain services or providers, Cubanski said. These private plans also have greater prior authorization requirements, which could impact access to care, he said.
On the other hand, traditional Medicare is “becoming increasingly unaffordable” for some beneficiaries, Cubanski said. Individuals who need a lot of medical services may face higher costs under traditional Medicare, he said.
What’s more, unlike Medicare Advantage, traditional Medicare has no out-of-pocket limit on the cost of medical services, Cubanski said.
More details on Medicare Advantage plans are available
Moeller said more information about Medicare Advantage plans will be available as beneficiaries shop for plans this year. Medicare’s Plan Finder will include more details about additional benefits Advantage plans offer, such as vision, hearing and dentistry, he said.
Prospective Advantage enrollees will also have access to more information about the doctors, hospitals and other care providers included in their plan provider networks. This information will mostly be found on insurance websites, Moeller said.
Moeller said there may be “some hiccups” in the newly available information and that beneficiaries may miss the opportunity to overcome Medicare Advantage open enrollment. Medicare Advantage open enrollment runs from January 1 through March 31.
New changes could impact prescription drug costs
Beneficiaries covered by original Medicare plans have the option of purchasing Medicare Part D to cover their prescription drugs. Those with Medicare Advantage can access these benefits through their specific plan.
No matter what, it’s important to review your preferences for next year to make sure your prescriptions will be covered.
“If a plan doesn’t cover all of your prescription drugs, I would cross it off my list,” Moeller said. “You want to make sure a plan covers all your medications.”
More zero-premium Part D plans are available that can reduce your monthly expenses, Moeller said. But annual deductibles for those plans are increasing, he said. Co-pays may also move to more expensive tiers, he said.
“Don’t lose sight of the fact that the main basis for your decision should actually be your overall annual costs,” Moeller said.
Notably, although more zero-premium Part D plans are available in some areas, overall the total number of plans is decreasing, Cubanski said.
“Shopping always pays off because you don’t know what you’re leaving on the table,” Cubanksi said. “Perhaps your current plan will no longer offer you the best coverage at the lowest cost.”
