Medicare’s Open Enrollment Feels More Like Open Season on My Brain
And it doesn't help when disinformation clouds the issues
This post is relevant to everyone, not just oldsters. We need Medicare for All, as I mention several times in this post. The best way to help promote discussion and debate is by restacking diverse opinions (as long as the opinion isn’t from the MAGA crowd, which has no agency).
You’ve got two days to grab yourself a juicy healthcare plan if you’re on Medicare (deadline December 7). The choices alone will probably send you to the ICU, but I managed to do it, so you can too.
But this post is relevant for everyone, especially the first part, a rant, which, as most of my readers know, is my specialty (aside from my other thoroughly researched and heavily cited works of wonder).
First off, the rant
No thanks, I’ll stick with my Medicare Advantage plan.
One of my favorite Substackers,
, who almost always gets things right, wrote what I consider a somewhat dangerous bit of advice1 on Medicare Advantage that I need to refute in a post (I already ranted a bit in a note).Later in this post, I provide a thorough review of Medicare options that I wish I had seen when I first chose a plan last year.
In Mr. Hartmann’s post, he correctly argued that Medicare Advantage is a scam invented by Republicans to degrade Medicare. The problem with his post is some bad advice to oldsters like me: Ditch Medicare Advantage because it is tainted by denials from the insurance companies involved. His citing of these denials is also correct. However, there’s more to it than that.
I agree that Medicare Advantage is part of the Republican plot to destroy Medicare, but as someone who is on Medicare, the complaints here about providing funds for vision and dental care that Mr. Hartmann and others pay for (“You and I pay for those freebies”) is off the mark.
Vision and dental care are essential for older Americans. Basic Medicare offers NO VISION or DENTAL care. A bad tooth can kill you if it’s not yanked out, and bad vision is almost a guarantee for older folks.
The author recommends I ditch Medicare Advantage and its zero copays and zero premiums in favor of expensive Medigap plans, which are typically offered by the same companies that offer the Medicare Advantage plans. You’ll see later in this post how those Medigap plans are laid out to sucker you into high premiums (but you’ll want them if you travel a lot).
Medigap premiums in my part of the country for decent plans can run up to nearly $500 a month. Anyone who wants to recommend these over Medicare Advantage is free to send me $300 -$500 per month to cover that expense. I’ll gladly accept the contribution.
But fair warning: I’ll probably just pocket the money and stick with my Medicare Advantage plan. UnitedHealthcare (for example) is likely to also turn down procedures through their Medigap plans. If they’re not doing that now (they probably are, but it has escaped the public eye), they will.
You can avoid the horrors of Medicare Advantage Mr. Hartmann describes by researching providers and picking one that doesn’t have as a bad reputation as United Healthcare. These actually do exist.
The zero premiums, zero co-payments, and dental/vision plans are legitimately good reasons to sign up with Medicare Advantage, as I explain in more detail later in this post.
Replace Medicare with Medicare for ALL
Medicare should be replaced with a full Medicare for All plan as envisioned by progressive Democrats. That’s where this debate should lead. Medicare as currently structured is insufficient. Basic Medicare requires a 20% copay for almost everything — hospitalization, doctor visits, ambulatory care. Medicare is not national healthcare by any stretch of the imagination. It offers nothing for vision or dental. Don’t require us to “fill the gap” with a “Medigap” plan. The very word, “Medigap,” demonstrates the government’s acknowledgment that Medicare is insufficient. It’s a sham.
When we speak of Medicare for All, we should be talking about the full scope of healthcare, including dental and vision, that many modern nations provide. It should be made available to all Americans. But Americans seem to want to keep healthcare expensive. Voting patterns bear this out. Just look at the clown they just voted into the Oval Office again.
About that murder of UnitedHealthcare CEO Brian Thompson
Although the author doesn’t advocate Thompson’s murder, he does point out in his article how much money the victim pulled in as CEO. I’ve seen comments on Substack and social media that come just a finger shy of applauding the assassination.
Shooting a guy in the back on a crowded street should be loudly condemned by everyone. It’s something that happens in failed states, not civilized republics.
The core issue is NOT the greed of corporate officers. It’s the refusal of Americans to vote for those who promote national healthcare plans. Shit, even Nixon wanted a national healthcare plan.2 He proposed universal healthcare when he was president. Since those days when even Republicans agreed on cornerstone social welfare programs, American voters have repeatedly spoken. America has shifted far to the right.
American voters have decided they prefer a failed state where millions of Americans die from insufficient healthcare, then shoot CEOs in the back when their claims get denied (I’m assuming this was the shooter’s motive because police found shell casings with the word, “denied” on them). It’s a disgusting situation.
Don’t blame the CEOs. Blame American voters. Blame, also, the Republicans who somehow convince uneducated Americans to vote for felons and predators over folks who would like to see Americans not getting ripped off by corporate healthcare providers. But don’t kill Republicans either, FFS. Just vote them all out of office. Holy shit. I shouldn’t even have to say this.
My Tour Through Medicare
Per the headline of this post, it was open season on my brain (like it apparently is on healthcare CEOs) as I reviewed my Medicare options during Medicare’s open enrollment period for 2025.
Part A, B, C, D, E, F, G, H, J, K, or L? Are there more letters? Medigap or Medicare Advantage? Are they the same? If I go with Part A, B, and D, what happens to Part C?
This year is not my first go-round through the Medicare gauntlet. I originally signed up with Medicare last year. I didn’t do a very good job of evaluating its offerings, partly because when I first ran into all those letters, I took the easy way out and just went with Medicare’s default enrollment option.
Mr. Hartmann is wrong. That choice was a mistake. Now I have no vision insurance, and I need it.
I’m hoping to help you avoid my mistake by walking you through my new and slightly improved process for this year. Forward it to the oldsters in your life if it doesn’t apply to you. Restack it, too, because this stuff is tricky. I wish I had seen this or bothered to research during my first go-round.
Medicare & You 2025
It begins with a book. Medicare calls it a pamphlet. I call it a book. My rules of American literature dictate that anything more than 100 pages is a book. The book is called Medicare & You 2025. By now, you should have received a printed copy if you are eligible for enrollment. If not, you can download it here.
Note: All of the Medicare information you read about in this article is derived from that book or the Medicare.gov website.
Although my journey begins with a book, to truly begin my journey, I visited the Medicare website at medicare.gov.3
The journey begins
When you first open up the medicare.gov website, you see something like this:
What you see may be different because website project managers are paid to change things, even for government websites. But this is what I got the last time I visited.
I already have a username and password, but if you don’t, this is where you create one.
After you log in or create an account, the place to go is… gosh, I had no idea. So I just surfed. And I remembered something that I realized last year when I signed up for Medicare: I had no idea what I was doing.
The way to fix that is to read the book I mentioned earlier, Medicare & You 2025.
Since I already have done that, maybe I can save you a little time, but just keep in mind that everyone’s needs are different. This article is not intended to be financial or insurance advice in any way. It is simply a report on my experiences.
My main goal this year, because I received an email from Medicare telling me it was, was to partake in the joys of open enrollment.
What is open enrollment?
For those unfamiliar with it, Medicare open enrollment is similar to open enrollment as defined by the Affordable Care Act (ACA).
Except that Medicare is a bit more labyrinthine.
I’d go so far as to say that whoever made up the word labyrinthine must have spent a day navigating Medicare options.
One of the things I do when I start a new book is to flip through it before digging in. That was a big mistake in this case. One of the first things I ran into was this page:
Have I mentioned how this entire process makes me feel?
This page was a clear indication that to avoid last year’s mistake, I needed to hide my eyes from such horrors and start at the beginning.
A quick overview
The fun begins on pages nine and 10. This is where we discover that there are two major options for Medicare:
Original Medicare — aka Part A and Part B, which allows you to choose doctors and specialists anywhere in the country. This is the part that Thom Hartmann, with good intent, suggests you focus on.
Medicare Advantage — aka Part C, which limits you to a network provider — is similar to how an HMO or PPO works.
The important thing to remember is that you can’t have both. You either get Original Medicare or you get Medicare Advantage.
The first thing I discovered last year was that no matter what I chose, I had to pay a premium. This surprised me because I had mistakenly thought that Medicare was universal healthcare for oldsters. And free.
It’s not free. You pay a premium of $174.70 if you make $103,000 or less per year. If you make more than that but less than $397,000, you pay $384.30.
Remember my rant about Medicare for All? If Congress critters finally create such a beast but it doesn’t ditch that premium, it’s not universal healthcare.
Anyhoo, this chunk of change is normally taken out of your monthly Social Security check or other government retirement funds like railroad retirement. So if you get $2,200 per month in Social Security benefits, you’ll get $2025.30 in your monthly check instead.
Original Medicare (Parts A and B)
If you choose Original Medicare (Parts A and B), you have 20% copayments for a lot of common services. Some things, like Covid and other vaccines, are free with no copay. But many basic services and testing come with a copay.
In addition, there are a lot of vital services not covered at all by Original Medicare: Like vision and dental care. These happen to be of primary importance to older folks (especially me), but they’re completely missing from the basic Medicare package.
Original Medicare is also where the attack of the letters begins. There are two types of Original Medicare: Part A and Part B.
Part A is hospital insurance. Part B is medical insurance.
Both of these trigger automatically when you turn 65. If you choose to do nothing, the government will automatically enroll you in Original Medicare, which it refers to as Part A and Part B.
Original Medicare also includes an optional Part D that covers prescription drugs.
If you’re wondering where Part C is, don’t worry, I did, too. Part C is a different method for accessing Medicare that is separate from Part A and Part B (and D). So for now, let’s skip it.
Part D is for drugs. That’s an easy mnemonic. The government does not enroll you automatically into Part D. Instead, the trusty manual (which I call a book) tells me to sign up for Part D with a private company.
“Oh, no!” was my first reaction to that. If I need a prescription, I need to make sure I’m covered under Part D? And I have to pay for it?
Yep, pretty much. For 2025, there’s a cap of $2,000 on how much you can pay out of pocket for prescription drugs. I’m surprised this isn’t called the Biden Cap because the Medicare book says so explicitly:
Because of President Biden’s new prescription drug law, in 2025, your yearly out-of-pocket drug costs will be capped at $2,000.
But American voters decided to get rid of that cap, most likely, by voting in the Predator in Chief. Sigh. I can’t wait to see the proud photo opp for that heist.
The other good news (for now) is that most Part D plans are free or have very minimal charges where I live. Your mileage may vary. Last year, mine was priced at 50 cents per month. Even I can swing that. This year, my plan is free, but I’m not enrolling in Part D this year for reasons I’ll chat with you later about (spoiler alert: I ditched Part A and Part B, and switched to Part C).
So if you sign up for Part A and Part B, remember to pick a Part D plan during open enrollment to cover your prescription costs. The monthly fee should be close to nothing if you scroll hard enough through your choices.
Discovering what Part A and Part B cover
Reading the book, I learned that under Original Medicare, you can use any doctor or hospital in the U.S. that accepts Medicare as payment (most do, but check before you set up an appointment).
The manual notes that you pay 20% of the cost of a service under Part B. But even this only occurs after you’ve paid a deductible.
Just like with private insurance, the 20% is called coinsurance. This is what can ruin you quickly. It’s rare to get a quote upfront when you’re seeking medical services, but if you plan on getting a routine checkup through Medicare Part B, you should ask the chirpy front desk person how much it costs when you set up a medical appointment. She may say, “You’ll only get that information if you pry it out of my cold, dead hands,” but it’s worth a shot.
Further reading in the manual led me to an exciting factoid that allows us to avoid that first 20% copay. It turns out that there’s a provision in Medicare that provides for a free wellness check every 12 months. I didn’t know that last year because I didn’t read the book.
The wellness check is not the same as a full physical, which requires a 20% copay. But it’s pretty close, and it’s a good way to get comfortable with a new doctor. It includes a few basics, such as measuring blood pressure and glucose levels. It’s also a good opportunity to get jabbed with important vaccines.
As I read more about Part B, things got darker. This is because, according to the manual, there is no yearly limit on what you can pay out of pocket under Original Medicare Part B. If my healthcare costs me a million dollars, I’m stuck with the bill.
Hospitalization (Part A) is grim, too. Hospitalization is free for the first 60 days, but you still pay a 20% copay for physician services while you’re in the hospital. After 60 days, Medicare hits you with a $408 daily fee. After 90 days in the hospital, that jumps to $816 per day.
It seems fair to say that only Congress critters could come up with a plan that charges you $800 per day for being incapacitated enough to be in a hospital for 90 days.
In other words, if you get Part A and Part B, either add on to it with Medigap or don’t get sick enough to call in the medical reinforcements.
Medigap
I’m a curious fellow, so I next wondered, as I read the manual, “Well, but, this kind of coverage is just not realistic. Why are you pulling me out of the ACA and into this dystopian world?” I was happy with my ACA plan, dammit.
Further reading revealed that our friendly neighborhood Congress critters must have been aware that they applied the screws to us because it turns out there’s something appropriately named Medigap.
This article is not intended to be financial or insurance advice in any way. It is simply a report on my experiences.
Medigap is supplementary insurance. It covers things that Medicare Part A and B (Original Medicare) don’t. The manual states that any kind of supplementary insurance is okay with the government: Employer insurance, Medicaid, or simply buying a plan on the open market.
This is where we move from the manual (as I mentioned, I call it a book) to the website.
But, danger alert. Don’t do this unless you are certain you want Part A and Part B. Like me, you might want Part C instead. But for now, let’s assume you decide to stick with Parts A and B. Medigap is only available if you choose those plans. Part C (Medicare Advantage), I must emphasize now, is a completely different way of accessing Medicare services.
When you sign up for Medicare Part A and B, you can choose from an assortment of Medigap plans if you wish to extend your coverage. It’s akin to Arnold Schwarzenegger’s Terminator character (the nice one) saying, “Come with me if you want to live,” but he then tells you that extending your life will cost you between $200 and $500 per month.
When you enroll for a Medigap plan during open enrollment or when you sign up for Medicare, you’re presented with a marketplace similar to what you find on the ACA website. The plans range from gold star plans to budget plans. They are mostly priced based on the kind of deductible you choose. The lower the deductible, the more expensive the plan.
In my area, none of them were priced under $180 per month. That fee is tacked on to Medicare’s original monthly fee ($174.70 in my case).
Medicare Advantage (Part C)
I found all these costs distressing. Luckily, I kept reading the book and discovered the all-important missing letter: C!
Medicare Advantage (aka Part C) is similar to the ACA (Obamacare). It’s an online marketplace for insurers. The process for acquiring a private plan is similar to using ACA’s online health marketplace. And Mr. Hartmann is right. It’s a privatization of Medicare. But it’s what I was faced with in making my choice. And American voters probably just added to the pain of future Medicare iterations.
Medicare Advantage acts as a full replacement of Part A and Part B and is labeled by Medicare as Medicare Part C. C is for Corporations. That’s my mnemonic for this.
This means that if you originally enrolled in Part A and Part B, Original Medicare, and then signed up for a Medicare Advantage plan, you’re out of the Part A and Part B plans.
With Part C, everything is governed by the corporate insurance company you sign up with during the enrollment process, although they must adhere to medical practice and billing standards established by Medicare. So if they’re denying claims, they’re probably breaking the law. Remember that. It’s important, because the day may come when you need to fire off a friendly letter with attorney letterhead reminding your provider of this overlooked fact. (My attorney is a guy named Sal).
If you are new to Medicare, Medicare Advantage is exactly what you are used to dealing with: You sign up with a health insurance firm, and they proceed to deny your claims, and you write the letter. Nothing beats familiarity, right?
You continue to pay the Original Medicare fee of $174.70 or $384.30 (or more if you’re making more than $397,000 per year) plus whatever the Medicare Advantage plan costs.
That money is collected the same way as under Original Medicare, through your Social Security or railroad retirement check. When you enroll, you have the option of overriding that payment option by asking to be billed for it instead.
All of this information is in the book that I should have read last year.
My decision
Eventually, we must come to a decision. Last year, I went with Original Medicare. I didn’t take the time to read about it, though, so I only got Part A, B, and D. I didn’t get Medigap. I can’t explain why. Maybe because I didn’t read the book.
I decided to spend a little more time studying Medicare options this year because I need what Medigap and Medicare Advantage offer (especially for vision care).
My choices revolved around these bullet points:
Am I okay with the limitations of doctors to one insurance network? (Medicare Advantage)
What if I travel to another state and need a doctor? (Original Medicare + Medigap)
What if I need vision care? (Medigap or Medicare Advantage is a must if I want vision care)
Dental care? (Medigap or Medicare Advantage)
What about the cost?
It didn’t take long to realize that my choice was really between coverage for local in-network doctors (Medicare Advantage) and coverage for doctors anywhere in the nation (Original Medicare — Part A and Part B).
Another consideration was the various reports I’ve seen that Medicare Advantage insurance companies are denying treatment and claims at an increasing rate as reported by Mr. Hartmann and others4, 5. This is because of another fact outlined in the book: like HMOs and PPOs, Medicare Advantage insurance companies must approve procedures, prescriptions, and the like.
But, as I said in my rant, I suspect there are billing problems with Medigap and we’re just not hearing about them. The same companies that offer Medicare Advantage plans are the ones offering Medigap plans.
I began to lean toward Medicare Advantage because I liked the idea of having everything under one roof: My vision, dental, and hospitalization. I don’t have a long history of health issues. I’ll roll the dice and hope I don’t get sick if I travel.
When I looked at Medigap plans, I thought that the vision stuff was not very well delineated in the offerings. I’m currently dealing with a vision issue, so again, another set of points in favor of Medicare Advantage, where plans typically go into greater detail about vision and dental care offerings.
Also? Cost. The Medigap plans are expensive.
I was pretty sure what I wanted to do, but no matter what, it all involved a well-known tool for anyone making health insurance choices:
I started shopping for Medicare Advantage plans. Suddenly the decision became much easier. Here’s why:
See all those zeros? Part B under Original Medicare requires both a copay and a deductible. On the surface, this is an easy decision. Under this Medicare Advantage plan (offered by Kaiser), there is no deductible, no copay for basic office visits, and no drug costs. It also offers a Part B premium reduction. I was unable to find out the amount on that, though.
This is significantly better than a 20% copay on a slew of services or the expensive Medigap plans. I also liked this bit:
That’s much better for me than Original Medicare, which sets no such limits.
But, and this is important, if I travel and need medical services out of network, I’ll get hammered with high medical bills under Medicare Advantage if I get sick while gambling in Vegas. I’ll gamble on staying healthy when I travel since I’ve never so much as gotten car sick on the road or seasick on a cruise.
Was that a good gamble to make? What gamble is good? But I know that I’m not happy with Part A and B (Original Medicare), so I’m switching. I can switch again next year if I hate it or get hit with a travel bug (I love puns, sorry).
My decision might be different if I had a bit more income to work with, especially if I was planning on traveling a lot. If that’s you, take a look at those Medigap plans. Those might be a better option.
Whatever you do, consider this article a reference point, rather than advice. My brain is still mushy from reading through Medicare & You 2025. My brain is not to be trusted until the comic book lady leaves my nest of broken neurons.
And also? Stop voting for Republicans. They’ll kill you without batting an eyelash. And they’ll probably convert Part A, Part B, Part C, and Part D to Part FU (suckers).
Notes
You may have noticed that the initial screenshot from the manual talked about more parts, such as Part G, etc. Those refer to supplemental insurance plans, generally Medigap. This is Medicare’s way of developing a standardized, state-based matrix based on each letter. For example, all Medigap plans with the letter G (Part G) would have to adhere to a specific set of offerings set by Medicare. Part F would represent a different set of offerings, and so on.
All private plans, whether through Medicare Advantage or Medigap, are required to follow standards set by Medicare. So says the book.
Neither Original Medicare nor Medicare Advantage covers international travel, although according to the manual, some Medicare Advantage plans may offer such coverage.
Medicare open enrollment ends December 7.
Footnotes
The Medicare Advantage Trap: What They Don’t Tell You; Substack. 2021. “Home | Substack.” Substack.com. 2021. https://substack.com/home/post/p-152589403.
Nixon pointed out that:
…overall healthcare costs have risen over 20% since 1971, and that the standing average cost of a day-long hospital stay is over $110. On top of the rising cost of healthcare, over 25 million Americans were still uninsured in 1974. 40% of Americans who were insured were not covered for visits to a physician’s office on an outpatient basis, and very few private health care policies covered preventative services. Furthermore, less than half of Americans under the age of 65 and almost none of Americans over the age of 65 had major medical health coverage.
Things, of course, are generally worse today in a society where healthcare is driving millions into bankruptcy.
Kidd, Leah. 2015. “The Nixon Comprehensive Health Insurance Plan.” Richard Nixon Foundation. November 5, 2015. https://www.nixonfoundation.org/2015/11/the-nixon-comprehensive-health-insurance-plan/.
“Medicare.” 2024. Medicare. Centers for Medicare & Medicaid Services. 2024. https://www.medicare.gov/.
King, Robert. 2023. “‘It Was Stunning’: Bipartisan Anger Aimed at Medicare Advantage Care Denials - POLITICO.” POLITICO. Politico. November 24, 2023. https://www.politico.com/news/2023/11/24/medicare-advantage-plans-congress-00128353.
Suhas Gondi, Kushal T Kadakia, and Thomas C Tsai. 2024. “Coverage Denials in Medicare Advantage—Balancing Access and Efficiency.” JAMA Health Forum 5 (3): e240028–28. https://doi.org/10.1001/jamahealthforum.2024.0028.
Thanks for reading!
"I’d go so far as to say that whoever made up the word labyrinthine must have spent a day navigating Medicare options." 😂😂 Great piece, Charles...I'm going to reread this carefully. Thank you for doing all this work to explain it to us...I had advantage for 90 days and didnt like it...but I do need to investigate more thoroughly.
Great post. I have been on an adva Tage plan since mid 2012.