Open Enrollment: What I’m Noticing
After years of helping people sort through Medicare choices, I’m retired now, but I still worry about the people making those decisions. This open enrollment, I’m noticing that the choices available to individuals seem to be getting narrower, especially when it comes to provider networks.
An HMO can be a good fit, but people need to know what its network actually includes. Is it local or regional, or can members use the carrier’s broader national network for routine care? That distinction matters if you travel for the winter or want to use doctors out of your area. With an HMO, members generally need to use providers in the plan’s network, with exceptions for things like emergency and urgent care. Carriers should make the reach of each network plain, so people know what they are choosing.
Some people may look to Original Medicare with a Medigap policy as a way to have more choice in where they receive care. Original Medicare lets people see Medicare providers anywhere in the country, as long as the provider accepts Medicare. But that choice can come with higher monthly costs, which may be difficult for someone living on a fixed budget. And Medigap does not generally cover prescription drugs, so people who want drug coverage also need to compare a separate Part D plan.
Those drug plans deserve careful attention too. Their covered-drug lists, pharmacy networks, premiums, deductibles, and out-of-pocket costs can differ, so a plan that works well for one person may not work well for another. People need to check their own prescriptions and pharmacies before choosing.
What I wish the system understood is how unsettling these yearly changes can be. A change in a plan or network can disrupt a person’s established care and leave them trying to figure out what comes next. It also creates extra work for providers and carriers. Healthcare needs a real overhaul, with stronger regulation and more public support, so people can count on stable, affordable care. That’s what I keep thinking about this open enrollment, even from retirement.
Wishing everyone the very best this coming year!
Rose
Thank you!
