Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert | October 14, 2021

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Table Of Contents
  1. Medicare Annual Enrollment Period | October 15 – December 7
  2. NEW ISSUE BRIEF | Retiree Auto Enrollment in Medicare Advantage Plans – Choice is Under Threat
  3. Special Report | Medicare Annual Enrollment Period Starts Tomorrow – Look Before You Leap (Even if the View is Somewhat Clouded)
  4. Free Webinar, October 20 (2-3 pm) | Medicare Enrollment Issues for 2022
  5. Free Webinar, October 28 (1-2:30 pm) | Spotlight on the Medicare Savings Programs

Medicare Annual Enrollment Period | October 15 – December 7

With the Medicare open enrollment period beginning on October 15, we encourage Medicare beneficiaries to choose carefully between traditional Medicare and joining a private Medicare Advantage plan. This is particularly important, as consumer marketing protections have been reduced and public promotions of Medicare Advantage are increasing – including on TV and in the mail. Here are some pros and cons regarding traditional Medicare and Medicare Advantage to consider:

Traditional Medicare allows access to all doctors, health care providers, hospitals and facilities that accept Medicare nation-wide.

  • All people in traditional Medicare have access to similar benefits, which are available to them wherever they are around the country
  • People in traditional Medicare usually do not require prior authorization to see  specialists
  • People with traditional Medicare can choose whatever Medicare prescription drug plan best serves their needs
  • People with traditional Medicare often have better access to home health care,  nursing homes, and rehabilitation
  • People with traditional Medicare often need to purchase a “Medigap” policy to pay for Medicare cost-sharing.
  • Lower-income people can get help paying for Medicare cost-sharing

Medicare Advantage plans are private plans, like HMOs. They usually limit your choice of doctors, health care providers, hospitals, and facilities to a “network” of certain providers within your local geographic area. (Unless the needed care is an emergency or “urgent.”)

  • Medicare Advantage plans can cut doctors and other health care providers from the plan network during the year
  • Medicare Advantage requires “prior authorization” from the MA plan for many health care  services
  • Medicare Advantage often includes a prescription drug plan and some additional “supplemental” benefits such as help with dental care, gym memberships, and other benefits for some participants
  • Medicare Advantage cost-sharing can be less than traditional Medicare, and MA plans are required to have a cap on out-of-pocket expenses. However, they also sometimes include co-pays not in traditional Medicare (for example – for home health care).
  • Lower-income people can get help paying for Medicare cost-sharing

For more information, see our Special Report.

NEW ISSUE BRIEF | Retiree Auto Enrollment in Medicare Advantage Plans – Choice is Under Threat

Increasingly, employers and unions that offer retirement health benefits are contracting with private insurance carriers to provide group Medicare Advantage benefits in place of traditional (or original) Medicare. The Center for Medicare Advocacy has heard from numerous dissatisfied beneficiaries faced with automatic enrollment in these types of plans; meaning, their former employer or union will automatically enroll them unless they affirmatively opt out, and as a result, in many cases, pay higher premiums. Some beneficiaries are concerned with their lack of choice. Others are disappointed by the coverage.

Automatic enrollment of Medicare-eligible beneficiaries into employer or union-sponsored group MA plans is a concern; among other things, it limits care options for millions of people and erodes the Medicare statute’s protection of choice.

Special Report | Medicare Annual Enrollment Period Starts Tomorrow – Look Before You Leap (Even if the View is Somewhat Clouded)

As noted in a recent CMA Alert, Medicare’s Open Enrollment period – also known as the Annual Election Period or Annual Coordinated Election Period – runs October 15 through December 7. During this time all Medicare beneficiaries can reevaluate their coverage, and make changes, whether they are in Original/Traditional Medicare with separate Part D drug coverage, or in a private Medicare Advantage plan. And there are many plans to choose from – in 2021, the average Medicare beneficiary can choose among 33 Medicare Advantage (MA) plans and 30 Part D stand-alone prescription drug plans (PDPs).

As discussed in our Special Report, however, while beneficiaries should review their MA and Part D coverage every year to determine if their current options meet their specific health care needs, most do not do so.  For those who do compare plans, the means of comparison – such as plan quality ratings – are often flawed.  And from whom should beneficiaries get their information?  In recent years, the Medicare program’s own materials have departed from a neutral presentation of information and have steered people towards MA plans – with a welcome, recent reversal.  Those with a pecuniary interest in a given beneficiary’s coverage choices – including insurance plans and agents and brokers – are happy to step in.  These dynamics contribute to a flawed system of coverage “choice” in the Medicare program.

Free Webinar, October 20 (2-3 pm) | Medicare Enrollment Issues for 2022

Join us for one of our most popular annual webinars and experience how supporting the Center can make a difference for new Medicare beneficiaries across the country.

This webinar will discuss the 2022 Annual Coordinated Election Period (ACEP), including outreach and education materials issued by the Medicare program, Medicare Plan Finder updates, common enrollment pitfalls, options when you miss your Initial Enrollment Period, and other considerations for Medicare beneficiaries and those who assist them. Policy changes, potential helpful legislation, and other updates for 2022 will also be discussed, including Medicare Advantage network adequacy and other changes made by final regulations.

Free Webinar, October 28 (1-2:30 pm) | Spotlight on the Medicare Savings Programs

Sponsored by California Health Advocates

•    Learn about the Medicare Savings Programs (MSPs)
•    Learn how MSPs can help some Connecticut residents pay for Medicare costs
•    Review a case study to learn how MSP assistance is calculated

Presented by Center for Medicare Advocacy Associate Director, Attorney Kathleen Holt, and Center Medicare Advocate Sue A. Greeno.

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