Medicare open enrollment is underway, and you’ve got until December 7 to review your coverage for next year. Last week, retirement journalist Mark Miller, who writes RetirementRevised, and I hosted a Substack Live to tackle what you need to know about changes in Medicare.
Yes, it’s a huge and dense topic because we all know Medicare has to be one of the most unnecessarily confusing things Americans are expected to figure out. And getting it right means understanding what impacts you, personally, this year.
You can do everything right, choose your Medicare coverage carefully, pay your premiums on time, and still get blindsided by something you didn’t know you even needed to ask.
Mark and I covered a lot of ground. We’re grateful so many people tuned in live. These were the four most urgent audience questions that I want to share with you.
1. Medigap is really important. What do you mean I can’t just switch Medigap policies?
First, a quick explanation because this is important. Original Medicare doesn’t pay for everything. You’re generally responsible for 20% of the cost of Medicare-covered Part B services, with no annual out-of-pocket limit under Original Medicare alone. That’s why so many people buy a Medicare Supplement policy, better known as Medigap, to help cover those costs.
Without Medigap, Original Medicare’s 20% has no ceiling. That means a serious illness could leave you with unlimited medical bills for Medicare’s 20% share. But with the right Medigap policy, that huge financial risk can disappear.
Someone in the room asked if her Medigap premiums could go up, and whether she could switch policies during open enrollment.
The short answer is yes, premiums can go up. But Mark explained Medicare’s annual open enrollment doesn’t just give you an automatic right to switch Medigap policies.
In many states, once you’re past your initial enrollment window, an insurance company can look at you differently. They’re able to pick apart your health history before agreeing to cover you. You might have to pay more. You could even be turned down.
Think about that. What if you suddenly developed a health problem, only to discover that changing your supplemental coverage isn’t the simple choice you assumed?
This is exactly the kind of thing you need to know before making your original Medicare decisions. My advice? Before choosing Medicare Advantage or Original Medicare, find out whether you can qualify for Medigap later because, by the time you need it most, the option might be off the table. And do not only choose based on TV ads promising no-cost coverage. That’s a trap!
2. What if I love Kaiser and don’t want to leave?
Another viewer asked a question I loved because it was so practical: If she wants to stay with Kaiser, does she have a choice?
Mark said that a lot depends on where you live. Kaiser offers Medicare Advantage plans in certain markets, and people may have options.
But here’s where I’d be careful. Just because a plan carries the same familiar name doesn’t mean every doctor, facility, or service is covered the same way.
I always say, start with the healthcare you actually need and want. This is highly personal. Then figure out which plan gives you access to it. Not the other way around.
3. I’m healthy. Why should I worry about prescription drug coverage?
An audience member shared that he has Original Medicare and a supplement. He’s not currently taking medications covered by his drug plan. That’s great, but I thought his question was especially important because he’s thinking ahead.
What happens if you do need an expensive prescription in February? Mark shared that you generally can’t just switch Part D plans in the middle of the year because your medication needs changed.
And if you skip Part D altogether without other qualifying prescription coverage, you could face a late-enrollment penalty later.
This is one of those situations where what looks like a smart way to save money today could cost you tomorrow. So the real answer is, even if you take no medications of any kind, compare Part D plans every year and keep qualifying drug coverage in place so you’re protected if your health changes.
4. Is Medicare Advantage always a bad idea?
Joining us live was a retired state employee whose former employer offers a Medicare Advantage plan. He shared that he can see doctors anywhere in the country.
Should he avoid it simply because it’s Medicare Advantage? Not at all! And I’m glad this question came up.
I’ve been pretty outspoken about how ‘salesy’ these Advantage plans are instead of educating people. For that reason alone, there are risks when you choose Medicare Advantage. What I worry about most are all the restrictions that can become painfully apparent when you get seriously sick.
But back to the question. Employer-sponsored retiree plans can be a different animal.
You still need to read through the fine print. Does nationwide access really mean any doctor? What about out-of-network charges and prior authorizations?
And I’d absolutely want this individual to find out if he gives up that employer retiree coverage, can he ever get it back? According to the Kaiser Family Foundation, nine out of 10 Medicare Advantage enrollees 65 and older don’t have a guaranteed right to buy Medigap later.
It’s what the media call, ‘The Medicare Advantage Trap’. Don’t throw away a potentially valuable benefit without knowing the answer.
Here’s What I Took Away From My Conversation With Mark
What bothers me about Medicare isn’t just how complicated it is. It’s that some of the most important consequences aren’t even known until years after you’ve made your decision.
We all know our health changes, our prescriptions change—and who here believes the insurance companies won’t change their plans?
The big problem is that your ability to snap your fingers and change coverage may be limited at a time when you need that flexibility most.
That’s why I wanted to chat with Mark. He’s spent years reporting on retirement and Medicare for publications including The New York Times, and he’s the author of Retirement Reboot. He’s one of those journalists who can explain complicated rules without making your eyes glaze over.
If you missed our conversation, you can watch it now while we’re in this open enrollment period until December 7. We got into a lot more than I could possibly cover here.
And I highly recommend subscribing to Mark’s RetirementRevised. He does terrific work keeping readers informed about the retirement decisions that really matter.
My biggest takeaway? Even if you love your current coverage and assume everything’s the same, take another look.
Because finding out what your plan doesn’t cover after you need it is a lousy way to learn about Medicare.
P.S. If you’re looking for a vetted, fee-only advisor who specializes in retirement planning, connect with us at Wealthramp.
