6 Questions which Show… Medicare is not for Sissies!

From the desk of Jo-Ann Ryan

Health insurance in general can be bewildering and intimidating, but Medicare health plans raise the confusion to a whole new level!   Ironically, it is the elderly and more vulnerable populations who are left to navigate the Medicare maze.

I have conducted countless studies about Medicare plans over my research career, and here are the 6 questions I consistently encounter:

  1. What type of plan do I have? A number of Seniors do not even know what type of Medicare plan they have or what it covers and does not cover.
  2. How do Medicare and supplement insurance work together? First of all, some seniors tend to believe that Medicare covers more than it does. Secondly, they do not fully understand the relationship between Medicare and supplement insurance and how benefits/payments are coordinated (e.g., Medicare being the primary payer, and the insurance company being the secondary payer).
  3. What types of plans are available and how do they differ? Often Seniors are unaware of, and/or do not understand, the three different types of plans – Medicare Supplement/Medigap, Medicare Advantage, and Prescription Drug (Part D) – each with different benefits that must be considered based on an individual’s needs.
  4. Is it possible to return to a Medicare Supplement plan once you have dropped it? Once you leave a Medicare Supplement plan, you have to go through the underwriting process again and may no longer qualify when you reapply.
  5. Who designs/determines requirements of Medicare plans? People often blame health insurers for plan restrictions and limitations (e.g., including the prescription donut hole). They do not realize that the Medicare plans which health insurers offer are heavily dictated by CMS regulations (Centers for Medicare and Medicaid Services).
  6. If I don’t take any medications now, or take ones that are not very expensive, why should I sign up for a prescription drug plan? There is a penalty for not signing up for a prescription drug plan when you turn 65. Seniors assume that if they take few medications and/or generic ones, that they do not need a plan and can get a plan later when they need it. They can but it comes at a higher cost.

At Doyle Research Associates, we’ve learned the language and complexities of Medicare so that we are able to explore and understand the consumer experience, and we have the patience and persistence required to do it.  After all, conducting research about Medicare is not for sissies either!