It’s Medicare open enrollment season, here’s what to do and not do

Whether you’re in Traditional Medicare or a Medicare Advantage plan, your Medicare Part B premiums will increase and your Part D prescription drug coverage will change in 2025. You should compare your prescription drug Part D options. And, you should be aware that sometimes it is less costly to get your drugs from Costco or another low-cost pharmacy than to get them through your Part D insurance.

To ensure you get covered for the care you need from the doctors and hospitals you want to use, without administrative hurdles, make sure you are enrolled in Traditional Medicare, the government-administered Medicare program.Only Traditional Medicare gives you the freedom to receive the care you need from the doctors and hospitals of your choice. Unlike Medicare Advantage, Traditional Medicare allows you and your treating physician to decide the care you need without second-guessing. And, with supplemental insurance you have few if any out of pocket costs. But because TM lacks an out-of-pocket cap, millions of Americans can’t afford it.

If you cannot afford Traditional Medicare or you cannot get supplemental coverage to fill coverage gaps, you have no choice but to enroll in Medicare Advantage. Medicare Advantage is always a gamble. You cannot make a meaningful choice of a Medicare Advantage plan. MA plans can overrule your doctor and deny you the care you need. Reports show widespread and persistent delays and denials of care and coverage in many MA plans. You cannot avoid that. The best you can do is pick a plan with a five-star rating and hope you don’t get sick.

Don’t assume that anything about your Medicare Advantage plan will remain the same in 2025. Your physicians and hospitals could be leaving the network. Your costs could be rising. Your prescription drug coverage could be changing. Review all your Medicare options carefully, including Traditional Medicare.

How to choose a Medicare Advantage plan? You can’t make an informed choice or avoid bad actor MA plans.You can’t know in advance whether an MA plan is engaged in widespread and persistent inappropriate delays and denials of care, as many of them are. The government cannot protect you from Medicare Advantage bad actors that do not cover your Medicare benefits, as required. The best you can do is pick a plan with doctors and hospitals you want to use in its network and hope they don’t leave. You can’t count on them staying. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care. Unfortunately, in Medicare Advantage, you are gambling with your health care and could incur thousands of dollars in out-of-pocket costs. Insurers have a financial incentive to deny care; the less care they cover, the more they profit. Don’t be seduced by “extra” benefits, which are often very limited and can come with high out-of-pocket costs.

Keep in mind that when you need costly and complex care, your Medicare Advantage plan is likely to require prior authorization and could overrule your treating physician, denying you coverage. You can appeal, but you might need to pay out of pocket for the full cost of your care. Even when Medicare Advantage plans approve your care, they generally force you to go through hoops and face delays before they will cover your care.

Don’t trust an insurance agent’s advice about your Medicare options. Unfortunately, insurance agents are paid handsomely to steer you away from Traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. You can’t know whether you can trust an insurance agent.

 If you have Medicare and Medicaid:

• You will have much easier access to physicians and inpatient services in Traditional Medicare than in a Medicare Advantage plan if you need costly health care services or have a complex condition. And, you will have no out of pocket costs.

For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a State Health Insurance Assistance Program (SHIP).

Here’s more from Just Care:

• Case study: Costco saves one couple hundreds of dollars over Medicare Part D
• Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
• Medicare Advantage offerings change little in 2025
• 24 health systems drop their Medicare Advantage contracts
• Medicare Advantage: The numbers speak volumes