Navigating medicare paralyzing

One morning recently, Eunice Korsah spent about half an hour on the phone being guided through the complexities of various plans for Medicare Part D, which covers prescription drugs.

Korsah is a retired nurse in Burke, Va., and her current drug plan was being discontinued. The insurer wanted to move her into one with sharply higher premiums.

“I decided, ‘No way,’” she said. But what to replace it with? She looked at the Medicare website for Part D plans available in her county and found 23, with monthly premiums ranging from $7.10 to $97.30.

Jack Hoadley, a health policy researcher at Georgetown University, has for two years volunteered with the State Health Insurance Assistance Program, or SHIP, the federally funded, free counseling service that helps Medicare beneficiaries find the coverage that’s best for them.

“Some very smart people just don’t know how Medicare works and get confused,” Hoadley said. For example, “it can make a $1,000-a-year difference if you’re willing to try several different pharmacies.”

Korsah, 74, had ready a list of her eight medications and their doses. Using the online Medicare Plan Finder, Hoadley narrowed the field to three suitable selections.

With the cheapest plan, from Wellcare, Korsah’s estimated total yearly drug and premium costs would be $301 a year if she used a CVS or Giant pharmacy — but $1,125 if she took the same prescriptions to a Walmart. Conversely, a Humana plan would cost $525 a year through a Walmart pharmacy, but more than twice that at CVS. With a Cigna plan, the best deal involved a mail-order pharmacy.

In theory, all beneficiaries who have traditional Medicare with Part D coverage, or who are interested in or enrolled in Medicare Advantage programs (an “all-inone” alternative offered through private insurers), should be making similar calculations during this annual open enrollment period, from Oct. 15 until Dec. 7.

It’s the reason that insurers’ pitches for plans are showing up in their mailboxes and inboxes, and on TV ads featuring Joe Namath and Jimmie “Dyn-o-mite” Walker.

“The idea is that consumers can reevaluate what coverage is best for them,” said Tricia Neuman, the executive director of the Program on Medicare Policy at the Kaiser Family Foundation. Since each year brings changes to Part D and Medicare Advantage — in premiums, benefits, copayments and provider networks —

shopping around makes sense.

But that’s not what happens.

For 2019, 71% of beneficiaries said they didn’t compare plans during open enrollment, according to a recent Kaiser study. The rate was even higher among Black and Hispanic beneficiaries, people older than 85 and those with lower income and fewer years of education.

Roughly half of respondents had never visited the official Medicare website, used its 1-800-MEDICARE help line or read the “Medicare & You” handbook that annually arrives by mail.

Kaiser found that in 2019, only 8% to 10% of beneficiaries voluntarily changed their Medicare Advantage or stand-alone Part D plans.

Some of that stasis may reflect satisfaction with coverage; it might also indicate an overwhelming amount of choice. For 2022, beneficiaries face an average of 33 Medicare Advantage plans to select from and 30 standalone Part D plans.

“It is hopelessly, needlessly complicated and it continues to get more complicated,” said David Lipschutz, associate director of the Center for Medicare Advocacy.

Even those who are motivated to comparison shop can have trouble finding reliable information. Most overtures and ads come from brokers or agents with financial incentives, though the offers may mimic official Medicare communications.

SHIP programs in every state, with 12,500 trained team members, represent the best source of unbiased information and work with more than 2.5 million people each year.