Chronic disease makes navigating Medicare enrollment especially tricky
The Medicare open enrollment period is an important time for all eligible adults to ensure that they find the right healthcare plan.
But it’s even more critical for those who have multiple chronic conditions, said Ken Thorpe, a professor of health policy at Emory University in Georgia and chairman of the Partnership to Fight Chronic Disease.
That’s because their health-care needs mean they likely go to the doctor more frequently than others, Thorpe said, and require a significant number of drug prescriptions. If they end up in an inadequate Medicare plan, it could lead to a surprising amount of out-of-pocket spending, he said.
People with multiple chronic conditions also continue to make up a larger share of Medicareeligible adults, placing them on the front lines in the battle to curb rising health-care costs in the United States.
In 2015, more than half of Medicare patients had five or more chronic conditions - such as diabetes, high blood pressure, high cholesterol, pulmonary disease and back problems - and they accounted for three-fourths of Medicare spending, according to data provided by Thorpe.
In 1996, only a quarter of Medicare patients were in that category, and they represented a little more than half of Medicare spending, he said.
Consumers are offered a range of Medicare options, but that can make finding the right plan tricky, some say.
“It can feel very overwhelming,” said Christina Reeg, director of the Ohio Senior Health Insurance Information Program (OSHIIP), an arm of the state Department of Insurance that offers education and guidance to Medicare beneficiaries.
When choosing a Medicare plan, people have to decide if they’re going to enroll in original Medicare or a Medicare Advantage plan, offered by private insurers.
While they cover all the services original Medicare does, and sometimes more, Medicare Advantage plans have provider networks. That is especially critical for people with chronic conditions, Reeg said, because “typically they might have providers they don’t want to give up.”
So they should make sure their doctors would be “in network,” she said. That isn’t really a worry for those on original Medicare.
Another option to consider is a Special Needs Plan. A type of Medicare Advantage plan, these privately offered plans are tailored around the care someone with a specific condition such as HIV, dementia or cancer would need.
Most Medicare Advantage plans also include prescription drug coverage, but those choosing the original Medicare route will need to choose the best prescription drug plan - known as Part D for their needs.
It’s an area where significant out-of-pocket costs could pile up, Thorpe said.
He recommends that Medicare beneficiaries list all the medications they’re on and do an online comparison of the plans to find which would have the lowest out-of-pocket cost. There are 26 Part D plans offered in Ohio for 2019.
Current Medicare enrollees should keep an eye out for updated cards being mailed during the enrollment window, Reeg said. Social Security numbers were removed from the cards in an attempt to reduce medical identity theft.
Taking time to research all available options reduces the chance of getting a hefty medical bill by surprise, Thorpe said.
“Consumers are generally just looking to see what they’d pay for a monthly premium, but that’s probably not the biggest part of what they’re going to end up paying,” he said.