www.forbes.com Open in urlscan Pro
151.101.2.49  Public Scan

Form analysis
0 forms found in the DOM

Text Content

Select Region
 * United States
 * United Kingdom

 * Mind
   Mind
    * Guides
      Best Online Therapy Cerebral Review Brightside Review BetterHelp Review
      Talkspace Review What Is Gaslighting? What Is Anticipatory Grief? What Is
      Cognitive Behavioral Therapy? Chronic Stress: Symptoms and Treatment

 * Body
   Body
    * Nutrition
      BMI Calculator Calories Calculator Best Diets Best Diets For Heart Health
      Of 2022 Best Diets For Diabetics GOLO Diet Noom Diet Mediterranean Diet
      Paleo Diet Keto Diet Anti-Inflammatory Diets To Try Best Anti-Inflammatory
      Foods How To Improve Gut Health Best Foods For Gut Health Guide To Vitamin
      D Benefits Of Turmeric
    * Fitness
      Best Fitness Apps Yoga For Beginners Best Yoga Poses For Health Easy
      Outdoor Workouts
    * Holistic Health
      Best CBD Oil Benefits Of CBD Oil What Is Reiki?
    * Personal Care
      Good & Bad Effects Of Alcohol Tips To Reduce Alcohol Consumption Best OTC
      Allergy Medications Melatonin For Sleep Natural Sleep Aids
    * Dental Center
      Byte Aligners Review SmileDirectClub Review How To Whiten Your Teeth
      Natural Teeth Whitening Professional Teeth Whitening Guide To Dental
      Implants Cost Of Dental Implants Guide To Adult Braces
    * Vision Care
      How To Prevent Eye Strain Guide To LASIK

 * Family
   Family
    * Baby
      Best Baby Formula Similac vs Enfamil Baby Formula Breast Milk: Freezing,
      Storing & Heating How To Get a Breast Pump Through Insurance Weaning:
      Switching From Milk To Formula How Long Does Baby Formula Last? Guide to
      Switching Baby Formula Colic In Babies Is Gripe Water Safe For Babies? How
      To Protect Your Baby From COVID-19 Is It Okay If I Don’t Breastfeed?
    * Pregnancy
      Best Pregnancy Apps Early Signs Of Pregnancy When To Take A Pregnancy Test
      Ritual Prenatal Multivitamin Review
    * Fertility
      Signs Of Ovulation Nutrients Needed Before Pregnancy Guide To Fertility
      Treatments How Egg Freezing Works Clomid For Infertility

 * Healthy Aging
   Healthy Aging
    * Aging In Place
      Best Medical Alert Systems Medical Guardian Active Guardian Medical Alert
      System Review Bay Alarm Medical On-The-Go GPS Help Button Review Are
      Medical Alert Systems Covered By Medicare? Best Walk-In Tubs How Much Do
      Walk-In Tubs Cost? Best Stair Lifts Best Home Elevators
    * Senior Health
      Best Hearing Aids From Audiologists Reduce Blood Pressure At Home OTC
      Hearing Aids Update Types Of Hearing Aids Blood Pressure By Age
    * Senior Lifestyle
      Best Mobility Scooters Best Moisturizer For Aging Skin Best Senior Dating
      Sites Best Flip Phones For Seniors Best Smartphones For Seniors
    * Caregiver
      Ways To Avoid Caregiver Burnout

 * Featured Guides
 * About Us
 * Forbes Health
 * Privacy Policy

Back to Forbes.com

 * Health
 * healthy aging

Advertiser Disclosure


MEDICARE OPEN ENROLLMENT IS EXTRA COMPLICATED THIS YEAR—HERE’S HOW SENIORS CAN
NAVIGATE IT SUCCESSFULLY

By Alena Hall
Editor

Fact Checked

Jessica Lester Editor
Updated: Dec 28, 2021, 11:55am
Commissions we earn from partner links on this page do not affect our opinions
or evaluations. Our editorial content is based on thorough research and guidance
from the Forbes Health Advisory Board.

Getty Creative

Using one word, how would you describe the Medicare health insurance landscape
in the U.S.? Dizzying? Maybe. Overwhelming? Probably. Confusing? Definitely.

You’re not alone. From Medicare Advantage plans to Medicare Supplement plans to
standalone Part D plans for prescription drug coverage, there are 24,000
different plans available nationwide for 2022. Even if you focus on Medicare
Advantage plans specifically and zoom in using your ZIP code and demographic
information, you’re likely still scrolling through a list of more than 30 plans
for which you’re eligible. 



Compare medicare insurance policies
zipcode
age
gender
Male Female
Submit



While the sheer quantity of options and their distinctions is enough to trigger
decision fatigue in the clearest of minds, it’s not the only reason navigating
the Wild West of Medicare Advantage enrollment is such a daunting task.
Third-party marketing, direct mailers and telemarketer calls frequently and
aggressively target those eligible for Medicare, promoting potentially
misleading information that can leave seniors feeling frazzled as they attempt
to make the best health care decisions for themselves. 

It’s time to quiet that chaos.


WHAT YOU REALLY NEED TO KNOW ABOUT MEDICARE ADVANTAGE FOR 2022

When a U.S. adult reaches age 65, they have two main Medicare coverage options.
They can enroll in Original Medicare, which includes hospital care (Part A) and
physician care (Part B) provided by the federal government, or they can enroll
in a Medicare Advantage plan, which is coverage offered by a private insurance
provider that includes hospital care, physician care, prescription drug coverage
and more. People who choose Original Medicare can also add to their coverage
with Medicare Supplement, or Medigap, plans. Medicare Part D, which covers
prescription drugs, is one of the most commonly used Medigap plans.

In this piece, we focus primarily on Medicare Advantage, as this marketplace
with numerous private insurance providers is where most confusion arises. 


THE NUMBER OF PEOPLE ENROLLING IN MEDICARE ADVANTAGE IS INCREASING

About 54 million older U.S. adults use Medicare in some form for their health
insurance coverage. More specifically, Medicare Advantage enrollment has been on
the rise for the past decade. About 11.1 million people were enrolled in
Medicare Advantage plans in 2010, and that number more than doubled by 2020 when
24.1 million people enrolled, representing 39% of all Medicare beneficiaries. 

About 70% to 75% of older adults choose health insurance coverage beyond the
scope of Original Medicare (Parts A and B), according to Ari Parker, a lead
advisor at Chapter, an independent Medicare advisor organization. “There’s
Medicare Advantage, which has prescriptions bundled in, and then there’s
Medicare Supplement, which is also known as Medigap,” he explains. Of the
remaining 25% to 30% of eligible seniors, many receive additional coverage via
other programs. “They have some type of additional coverage administered through
the government like [Veterans Affairs] VA benefits or Tricare if they’re
military veterans. It might be through a retiree plan as well,” says Parker.

In short, most eligible seniors find it necessary to get supplemental coverage
beyond Original Medicare, many of which opt for Medicare Advantage plans.
Meanwhile, the Medicare system as a whole is supporting more seniors than ever
before, due to more older adults living longer as the next generation achieves
eligibility. As this significant growth continues, we can expect to see the
costs associated with maintaining such a massive infrastructure increase as
well, says Dave Rich, founder and CEO of Florida-based insurance technology firm
Ensurem. 

“In less than a decade, we’ll be adding 17 million people into Medicare—that’s a
lot of folks,” says Rich. “Costs will continue to rise because the 85+
population is expanding greatly and we’ll have higher levels of chronic
conditions. You have to think about all the claims costs and the increases in
those claims costs over time. Chronic conditions are very expensive.” 

For example, diabetes is the most expensive chronic condition in the U.S., and
61% of diabetes costs come from care for people age 65 or older, which is mainly
paid by Medicare.


PLANS ARE CHANGING—JUST LIKE THEY DO EVERY YEAR

Third-party marketing often creates a sense of urgency for seniors to change
their current Medicare plan by highlighting all the ways plans changed from 2021
to 2022. While this fluctuation is very much real, it’s definitely not something
to panic about.

“Plans change every year,” says Parker. That’s why everyone should confirm their
coverage details on an annual basis. “Even if you’re perfectly happy with your
plan, it might not be the same plan for the next year. In fact, it’s usually
not. Typically, there’s variation,” he says.

“ Generally, it’s always important to review your plan because the drug
formulary (the list of prescription drugs covered by the plan) changes each
year,” adds Parker. “Also, your medications are changing. If you’ve had a
medication change, then the plan you’ve had might not cover it in the way you
would have expected.”

Rich confirms that more people changed their Medicare coverage in 2021 compared
to previous years, and he and his team have a hunch as to why. “What we’re
finding is people are more accustomed to shopping—they have another year of
experience under their belt in looking at the different plans out there,” he
says. “I also think the [COVID-19] pandemic has put their health care front and
center. More than anything, [third party marketing] creates this churning
effect. They feel like, ‘Wow, it’s 2022, I have to change because there are all
new plans.’ But the truth is plans change every single year.”

However, there are some larger trends worth noting. Many plans for 2022 have a
greater emphasis on telehealth, which both Parker and Rich expect is related to
the pandemic and more people feeling comfortable with seeing their doctors over
a video call. “In fact, many Medicare Advantage plans [for 2022] offer $0
telehealth visits,” says Parker.

Another important change is the way in which some plans are pricing insulin for
older adults in need of diabetes management. “Many plans have insulin at a much
lower cost in 2022 than in 2021, so if you have diabetes, it’s very important to
review your plan because you might find one that offers far more savings for
your medications,” says Parker.


HOME DIABETES TESTING

Check your levels from the comfort of your own home. Get accurate lab results
fast from LetsGetChecked. Get 30% off with code FORBES30.

Request Your Kit



COSTS ARE FLUCTUATING

You cannot consider a plan’s changes in coverage without assessing how its costs
are changing as well. Let’s stick with the example of reduced insulin prices for
seniors with diabetes. “If these Medicare Advantage plans are now covering more
of the costs of insulin and the government hasn’t increased their reimbursement
of those plans, what’s going to happen?” asks Rich. “There’s either going to be
a premium increase or there’s going to be a benefits reduction.” The
cost-benefit scale ultimately has to balance.

“There’s no free lunch out there,” says Rich. “They’re all for-profit plans [in
Medicare Advantage], so it sounds great, but there’s going to be a give-up
somewhere.”

While premiums, deductibles, copays and out-of-pocket maximums for Medicare
Advantage plans run the gamut, every senior with Medicare Advantage coverage is
required to pay the Medicare Part B premium (part of Original Medicare) in
addition to their private plan’s premium. These costs have increased gradually
over the past decade.

And costs continue to rise—the standard monthly Medicare Part B premium for 2022
is $170.10, an increase of $21.60 from $148.50 in 2021.


COVID-19, THE RISE OF TELEHEALTH AND THE DEFERRAL OF TREATMENT

It’s no surprise that private insurance companies offering Medicare Advantage
plans for 2022 are focusing more closely on telehealth-related benefits. As we
near the close of our second year navigating the COVID-19 pandemic, it’s clear
how many people—especially older adults considered more vulnerable to the
virus—avoided going to the doctor to reduce the risks associated with leaving
home altogether.

“COVID-19 has reduced utilization,” says Rich, referring to the extent to which
seniors are—or aren’t—using their various plan benefits. “UnitedHealthcare had
to pull three of their plans [for 2022] because they weren’t spending 85% of the
premium [the plans brought in]. Regardless of whether it’s coming from the
government or the beneficiary, of that total premium, it’s required [by law]
that 85% go out in benefits. But because of COVID, seniors aren’t going to the
doctor,” explains Rich.

Clearly, pandemic-related behaviors impact the landscape of plans today, but
they are also likely to place additional strain on the Medicare system in the
future. “If seniors aren’t going to the doctor now, what you get is potential
pent-up morbidity (the cost for insurance providers) in Medicare,” says Rich.
“When they start going again, they might have chronic conditions that they
didn’t take care of earlier, so morbidity could go up in the coming years. We
don’t know that for sure, but that’s what we’re thinking might happen.” 

Should this projection ring true, the compounded cost increases for insurance
companies would likely trickle down, creating higher premiums for seniors in
need of care. 


THE MOST IMPORTANT ELEMENTS OF MEDICARE ADVANTAGE COVERAGE

Now that you have a clear grasp of the key forces impacting Medicare Advantage
plan coverage and pricing for 2022, let’s dig into exactly which plan details
should be prioritized when looking at your current options. 

“We often get caught up in the frills and the glitter, but the substantive parts
of a plan are the hospital network, the physician network and the prescription
drug formularies,” says Rich. “That’s what you should make your selection on
because that’s where the morbidity, or the costs of claims, is highest. That’s
where you want to make sure you’re covered.”

In fact, hospital care, physician care and prescription drugs collectively
accounted for more than 60% of U.S. national health expenditures in 2019. If the
majority of resources are invested in these areas, it’s only logical to consider
how robust that coverage is and how much it could support you over the course of
a year.

Once you’ve evaluated the big three areas, consider the less risky benefits,
advises Rich. “For seniors, dental and vision coverage is very important, so I
would look at those and the networks of those plans,” he says. “After that, look
at transportation and meal benefits for outpatient surgery, as well as
over-the-counter benefits. Some have hearing aid benefits, too, but I put things
like that in a third tier because, in terms of cost, it’s just so much lower.”


WHY NO SINGLE PLAN IS THE “BEST” PLAN

Even with this guidance, it’s virtually impossible for anyone to identify one
plan as the absolute best in the bunch across the board, according to both
Parker and Rich. It comes down to your specific needs and how well a plan can
balance them.

“And it’s really not until the end of this annual enrollment period that we will
have a good handle on the changes in premiums, deductibles and benefits and
whether the plans are better or worse than they were in 2021,” adds Rich. 

With that said, it’s certainly possible to find a plan right now that meets the
majority of your coverage needs by shopping the marketplace.


A STEP-BY-STEP GUIDE TO SHOPPING FOR MEDICARE ADVANTAGE COVERAGE

Regardless of whether you’re looking for fresh insight during the 2022 annual
enrollment period (which ran from Oct. 15, 2021, to Dec. 7, 2021) or preparing
to turn 65 and exploring Medicare Advantage plans for the first time, Rich
recommends the following shopping process to keep things clear, simple and—with
a little luck—the opposite of overwhelming.


1. START WITH CMS

Get your bearings by going to the original source itself—the Centers for
Medicare and Medicaid Services. It provides a plethora of helpful explainers on
its website, and it mails a Medicare guide to most seniors every year. Start
there.


2. SEARCH THE WEB

Use a website like Medicare.gov and its plan comparison search tool to get a
feel for how many plans are available to you in your county, as well as how they
vary in both price and coverage. (Both Chapter and Ensurem offer search tools as
well.) Forbes Health hosts an abundance of helpful information as well,
explaining the differences between types of plans, what each type of plan covers
and the best insurance providers to consider first as you begin your search. 


3. SEARCH BY HOSPITAL

Once you’re looking at the list of plans for which you’re eligible, enter your
preferred hospital network information to further narrow the list to only plans
that consider your hospital in network.


4. SEARCH BY PHYSICIAN(S)

Just like you did with hospital details, enter your preferred physician(s) to
refine the list to only plans accepted by the doctors with whom you trust and
want to maintain a relationship.


5. SEARCH BY PRESCRIPTION DRUG(S)

Next, enter the prescription drug(s)—and doses—you currently take to see which
drug formularies will give you the most cost-effective coverage of your
medications.


6. CONSIDER YOUR EXPECTED UTILIZATION

At this stage, you might still have a list of 15 plans in front of you. Ask
yourself how much you think you’re going to be using the benefits of the plan
over the course of the next year.

“If you’re healthy, then you probably want a high out-of-pocket maximum, a low
copay and a high deductible, which means in the infrequent times you go [to the
doctor], you pay a small amount but you’re really not going to have any
catastrophic events where you’re going to hit your out-of-pocket maximum,”
explains Rich. “Someone who is sicker might have a different scenario where they
would want a higher monthly premium but a reduced out-of-pocket maximum so that
when they go to the doctor frequently, after that out-of-pocket maximum is hit,
the plan covers them 100%.”


7. BROWSE ADDITIONAL COVERAGE

If you still find yourself staring at a few plans, compare them based on other
health care needs you want to prioritize, such as dental, vision, hearing,
over-the-counter or transportation coverage. This final criteria should help you
identify the 2022 plan best suited to your current needs.


WORKING WITH INSURANCE AGENTS

If the guide above still incites a wave of panic or you just don’t want to wade
through these waters alone, you can seek additional assistance from an insurance
agent or advisor. But know that not all agents are the same.

Some agents, often referred to as independent or agnostic agents, have access to
all available plans in your area, are licensed to sell all of those plans and
receive the same commission no matter which plan you choose. It is their job to
sell you health insurance coverage, and they do benefit from that sale, but
because every sale carries equal weight for their bottom line, they are more
likely to approach the plan selection process with your best interests in mind.

Other agents might only have relationships with specific carriers or receive
higher sales commissions from those carriers when they sell certain plans. If
you choose to work with one of these agents, be aware of these limitations and
inherent biases.

To find an advisor or agent in your area who can show you all plans relevant to
you and help you make your selection, search a phrase like “independent Medicare
advisors” and carefully review the options that appear. You can also look for
the phrase “first-tier, downstream related or entity” (FDR), says Rich. Such
organizations operate under significant oversight, are regulated with audits and
phone call recordings, and prioritize keeping your personal information private,
he says.

Meanwhile, many seniors already work with what the industry calls a “kitchen
table agent,” an individual they trust to come into their home—often
literally—with a handful of plans to simplify the shopping process. If
maintaining this existing relationship is important to you, consider asking your
agent the following questions:

 * How many plans do you search across?
 * How do you conduct that search?
 * Are you licensed and appointed with each of those plans? 
 * What are your security procedures for protecting my Medicare beneficiary ID
   and list of doctors and prescriptions?

Based on their answers, you can better determine how that agent is serving you
in your plan selection process and protecting your private information.


BEWARE OF MEDICARE SCAMS

As if navigating the noise of third party marketing and sliding past sketchy
agents isn’t enough work, there’s also serious Medicare fraud to be aware of.
From misleading direct mailers to pushy phone calls to social security identity
theft, seniors are taken advantage of every day.

Want to avoid Medicare scams entirely? There are a few simple steps you can
take:

 * Protect your private personal information by storing ID cards, medical data
   and more in a secure place.
 * Don’t answer calls from phone numbers you don’t recognize. (If it’s an
   important call, they’ll leave you a voicemail. Since spammers can leave
   voicemails, too, only return the calls of people you know.)
 * Question all Medicare-related materials received to either your mailbox or
   inbox (with the exception of the guide you receive from CMS).
 * When in doubt, do your research. Talk to independent sources and let their
   expertise give you peace of mind.


SOURCES

A Snapshot of Sources of Coverage Among Medicare Beneficiaries in 2018. Kaiser
Family Foundation. Accessed 10/25/2021.

A Dozen Facts About Medicare Advantage in 2020. Kaiser Family Foundation.
Accessed 10/25/2021.

Memo Signals Biden Admin Will Keep Close Eye On MA Marketing Actions. Inside
Health Policy. Accessed 10/25/2021.

Insulin. Medicare.gov. Accessed 10/25/2021.

The Impact of the COVID-19 Pandemic on Medicare Beneficiary Utilization and
Provider Payments: Fee-For-Service (FFS) Data for 2020. ASPE Office of Health
Policy. Accessed 10/25/2021.

Health insurance rights & protections: Rate Review & the 80/20 Rule.
HealthCare.gov. Accessed 10/25/2021.

How to Identify First Tier, Downstream, and Related Entities (FDRs). Provider
Trust. Accessed 10/25/2021.

Agent Commissions in Medicare and the Impact on Beneficiary Choice. The
Commonwealth Fund. Accessed 10/25/2021.


MORE FROM  

 * RESOUND HEARING AIDS REVIEW
   
   By Sandra Gordon Contributor

 * ACORN STAIRLIFTS REVIEW
   
   By Elaine Shelly Contributor

 * RHEUMATOID ARTHRITIS: SYMPTOMS, TREATMENTS AND MORE
   
   By Angela Haupt Contributor

 * BEST ALL-TERRAIN MOBILITY SCOOTERS OF 2022
   
   By Chauncey Crail Contributor

 * A GUIDE TO THE BEST WALKERS FOR SENIORS
   
   By Elaine Shelly Contributor

 * THE ACTUAL COST OF HEARING AIDS
   
   By Sandra Gordon Contributor

© 2022 Forbes Media LLC. All Rights Reserved. Our website services, content and
products are for informational purposes only. While our team of experienced
journalists and medical experts offers timely wellness insights, news and
reviews, we do not provide medical advice, diagnoses or treatment.
 * AdChoices
 * AdChoices
 * Privacy Statement
 * Terms and Conditions
 * About Us
 * Send Us Feedback
 * Jobs At Forbes
 * Reprints & Permissions
 * Forbes Press Room
 * Forbes Quote of the Day
 * Advertise