What Are Medicare’s Biggest Challenges Today & Why

Medicare’s Biggest Challenges Today from Medicare Industry Experts

Applying for Medicare for the first time can be challenging. For most, employer coverage is what is they use before receiving Medicare.

Employer benefits can be different than the plans available through Medicare.

While some can get a Medicare Group plan through an employer, most do not have that option.

Either way, talking with someone who understands Medicare, the different plans available, and what you need from a policy, is your best option.

Here’s what other industry experts had to say.

William A. Dombi

“Applying for Medicare is highly complicated by the deluge of marketing that comes from Medicare Advantage plans beginning months before eligibility. The plan marketing is not balanced with solid information about traditional Medicare, an option that may fit prospective enrollees better than managed care.” – William A. Dombi – President of the National Association for Home Care & Hospice

Many people find complications with Medicare, especially for people who have had employer benefits for most of their lives. Working with an agent that subsidizes multiple companies is beneficial to prospective enrollees.

Having some additional coverage allows the beneficiary to minimize financial risk. With Medicare only, there is no out of pocket maximum, leaving people underinsured.

Michelle Seitzer

“Most seniors and their family members find the complexity and nuances of applying for Medicare very challenging. Don’t try to do it alone! Pennsylvania offers a program called APPRISE, which is free health insurance counseling designed to help older Pennsylvanians with Medicare.

I’d highly recommend seniors and families find a reputable expert partner like an APPRISE counselor (or whatever comparable program/resource person would be available in your state of residence) to walk them through the application process.” – Michelle Seitzer – Caregiving Advice

Seniors and their family members should have someone walk them through the application process. These health insurance counselors and insurance agents are great resources.

They have a fiduciary responsibility to make sure beneficiaries are in the best plan for them. The policy that fits your neighbors’ needs might not be the same plan that fits your needs.

Rebecca Gilbert, MD, PhD

“Medicare does not pay for every expense. For example, it only pays for 80% of the fees for doctor visits. Many people want to purchase a supplemental insurance plan to cover what Medicare does not. Choosing a plan for the wide array of available options, can be confusing and difficult to navigate.” – Rebecca Gilbert, MD, PhD, APDA Vice President, Chief Scientific Officer.

Plan F will cover the 20% Medicare doesn’t cover on services. I understand plans can seem overwhelming, and there are many different plan options available.

Working with a Health Insurance Counselor or an Insurance Agent can make navigating the challenges of Medicare easier.

Sarah Deal

“For most Medicare recipients, choosing a Medicare policy is confusing. The word “Medicare” is intertwined with other plans, such as “Medicare Advantage” (e.g. “UHC Medicare”, “Aetna Medicare” etc.) Patients often think they have traditional Medicare when, they have chosen a Medicare replacement policy. The differences in Medicare Advantage plans and Medicare aren’t made clear until insurance is a requirement. Medicare Advantage plans are cheaper; however, they frequently have less providers in network and provide less coverage, resulting in higher co-pays.” Sarah Deal – Director of Senior Services for Interim HealthCare of the Upstate

Having an Insurance Agent or Counselor that is very clear on the plan details is essential. Insurance Agents need to be insisting on Medicare Supplements; they offer more comprehensive coverage and allow beneficiaries to see any doctor that accepts the assignment.

Medicare Seminars are beneficial to prospective recipients; they allow people to get information, ask questions, and share options.

Garrett Ball

“The biggest challenge that seniors face when going on Medicare is confusion about benefits, deadlines and processes.

Because of the enormous amount of information that seniors receive leading up to their 65th birthday or retirement, many seniors are paralyzed by the fear of making the wrong choice or confused by the system itself.

In my experience, many people applying for Medicare don’t understand how to start the process of applying.

Those that are already receiving Social Security benefits have automatic enrollment into Medicare upon turning 65, so that does simplify the process for people in that situation.

But for those that are not yet receiving Social Security benefits, it is a challenge to know what to enroll in and when they should enroll.

There is not one document that seniors receive from Medicare that explains, in easy-to-understand terminology, the steps that one should take when applying for Medicare.

Additionally, this is even more complicated for seniors that are continuing to work past age 65 or are covered by a group insurance plan of some type.

The decision of whether to take Medicare when they are first eligible is a decision that leads to confusion and can have potential long-term consequences. Medicare has late enrollment penalties for Part B (medical coverage) and Part D (Rx coverage).

So, if a senior does not enroll on Medicare’s predetermined time schedule, they can face these financial penalties, which are steep and stay with you in perpetuity.” Garrett Ball – Medicare Specialist at Senior.com

This is the most significant challenge seniors face when going on Medicare. I believe all seniors should have, at some point, a case manager or insurance agent to help them through the process. To enroll in Medicare, you go through Social Security’s website.

Overcoming Medicare’s Biggest Challenges Today

The best advice one can give is to read on Medicare and ask a professional your questions. It might not happen on the first day, but eventually, you will become familiar with Medicare.

Just like insurance counselors and agents, beneficiaries should frequent Medicare’s website. There’s a lot of information on how to enroll and how Medicare works with other Insurance.

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