(Most of) Your clients miss these five things about Medicare

Most beneficiaries are left scratching their heads trying to figure out Medicare. A recent survey highlights some of the top misconceptions they carry about the program. Let’s break down these misunderstandings and outline what they need to know to make more informed decisions.

26% of beneficiaries don’t know when AEP starts

Over ¼ of enrollees don’t know that the Annual Enrollment Period (AEP) begins on October 15 and ends on December 7. As a licensed health insurance agent, you know that this is the best (and often, only) window they have to evaluate their Medicare options. Communicate early and often about these timelines across a variety of channels – mailers, email, and social graphics are common elements. 

48.7% of enrollees believe there is no Part A deductible

Your Medicare Advantage enrollees might be forgiven for not knowing this one. Many Medicare Advantage plans do not have a deductible for inpatient hospital or skilled nursing services; instead, your clients may be responsible for a copay for a certain amount of days. 
But, if they’re on Original Medicare, they’ll need to know there will be a $1,632 deductible per benefit period in 2024. Some Medicare Supplement plans may cover all or part of this expense. If not, they’ll be responsible for this charge each time a new benefit period begins. Speaking of which…

54.2% of beneficiaries aren’t quite sure how Part A benefit periods work

Medicare Part A doesn’t work like many other sources of insurance – your clients may have to pay that $1,632 deductible several times per year. Here’s why:

When hospitalized, they’ll be responsible for fulfilling that deductible before Medicare Part A pays for any part of their care. Once the deductible is satisfied, clients will pay $0 for days 1-60 in the hospital, $408 per day (in 2024) for days 61-90, then $816 per day (in 2024) for days 92-150 (if using lifetime reserve days). After that, if you still need more care, you’re on the hook for all costs.   

Once released from the hospital, another 60-day countdown begins. If they’re re-admitted during the next 60 days, it will be treated as part of the same benefit period. Your client will be responsible for any applicable copays.

But, if they stay out of the hospital for at least 60 days,  a new benefit period begins the next time they’re hospitalized. The deductible will need to be fulfilled (again), and then daily copays will apply.

And so, someone can be responsible for the Part A deductible several times within a calendar year. Send your clients our video on Part A benefit periods if they need a visual aid.

73.5% of enrollees aren’t familiar with excess charges

Your Original Medicare clients should ask their doctors whether they accept assignment from Medicare – not just whether they can be seen. Accepting assignment means a doctor agrees to take the Medicare-approved payment for any services provided. If the doctor doesn’t accept assignment, they may charge your client up to 15% more than the Medicare-approved amount for their care. Unless they carry a Medicare Supplement policy that accounts for excess charges, your clients will be spending more than they planned.

They’re not sure what Original Medicare covers

Besides the inpatient hospital care we’ve already talked about, Original Medicare covers a wide variety of other services. 73.4% of beneficiaries correctly believe that Medicare Part B covers an Annual Wellness Visit, but things get dicey afterward.

• Only 64.2% correctly believe that Medicare Part B will cover a flu shot
• Only 54.3% believe that preventive services are covered
• Only 30.7% know that Part A covers hospice care
• Only 29.1% correctly identify durable medical equipment like walkers and wheelchairs as covered
• 28.8% realize Medicare covers inpatient and outpatient mental health treatment

But, here’s the most dangerous misconception: 23.6% of beneficiaries believe Original Medicare will cover the drugs they get at the pharmacy. It won’t. Instead, your clients will need to obtain Part D Prescription Drug Coverage through either a stand-alone plan or a Medicare Advantage plan with prescription drug coverage (MAPD). Our Part D explainer video can help drive this home.   

Knowing is half the battle

Now that you know what your clients are getting wrong, you can help them get it right! Leverage your first-quarter follow-ups, soup up your social media, or run educational events to spread your expertise far and wide.

Curious about these stats? Read the full report.