Medicare Complexity Taxes Counseling Resources Available to Beneficiaries

Kathryn Paez, Jennifer Lucado, and Deepa Ganachari

As the next Medicare annual open enrollment period approaches—October 15 to December 7—millions of Medicare beneficiaries must decide whether to change their coverage options. This may include switching from original Medicare (Part A and B) to Medicare Advantage, shopping for a new Medigap policy, or changing to a different Part D prescription drug plan.

In this qualitative study with volunteer counselors, consumer advocates, and insurance brokers, AIR researchers found that many beneficiaries are overwhelmed by Medicare’s complexity and could benefit from one-on-one counseling to help them make better choices.

Although there are many printed and web-based materials available to help beneficiaries make more informed decisions, beneficiaries may be surprised by Medicare Advantage’s out-of-pocket costs and network limitations. They may be unaware of the limitations on switching Medigap plans and back to original Medicare from Medicare Advantage. Beneficiaries may not realize they need to purchase a separate Part D drug policy. During fall open enrollment, brokers and State Health Insurance Assistance Program (SHIP) counselors may struggle to meet the demand for assistance.