The ACA Open Enrollment Period (OEP) started this morning. It will run through at least January 15th in almost every state (Idaho is weird). Let me steal some notes from last year:
We are in open enrollment season for health insurance. The Medicare Annual Enrollment Period started last week. The Affordable Care Act Open Enrollment Period starts now. Many companies are offering their employees an open enrollment period sometime soon.
I just want to highlight a few things.
1) CHOICE IS TOUGH — we have a great deal of very good evidence that choice is really tough. People routinely make objectively bad, dominated choices. People are subject to known and predictable cognitive biases. Some new research by Brot-Goldberg et al that used automatic re-assignment in Medicare Part D to show that people have extremely short duration intense attention spikes when they get hit with the equivalent of a 2×4 across the nose; otherwise inertia wins.
2) Get help! Insurance is complex and complicated. Most people shockingly don’t spend 40+ hours a week thinking about health insurance for a decade or more and find it interesting enough to get a PhD on the subject. Navigators and assisters are helpful as we speak a weird language that is complex even within our jargon. Brokers who are interested in long term relationships have strong incentives to make decent enough to good enough choices. Let’s talk in comments!
3) Satifice — Good enough can be more than good enough. Unless you are a medical trainwreck with a diagnosis history longer than a CVS receipt (Hi Mom!), you’re operating in a world of uncertainty. You don’t know for sure what next year could look like. Make reasonable guesses that are defined by your capability to absorb losses and value on different criteria (network, doctor relationships, ease of use, costs, predictability etc). The goal is not to get a perfect retrospective choice but a good enough prospective choice. Let’s avoid the absolutely hideous and bad choices and call it a good win.
4) Give yourself grace — this is a tough decision.
Scout211
I was surprised and pleased when we got a postcard in the mail informing us that we could sign up for vision and dental benefits through the federal employees benefits plan. We have Medicare and Tricare-for-Life for medical and prescription drugs but no vision or dental care.
It’s a small number of seniors who might qualify but if you do have Tricare-for-Life, you might be eligible to purchase dental and vision care through BeneFeds.gov starting November 11.
We have been paying out of pocket for vision care and paying for a retired employees dental plan through my husband’s university that has limited options. So this is good news for us.
Anonymous At Work
Satifice doesn’t get enough credit. Need to use the word repeatedly until multiple economics profs at University of Chicago have their heads explode.
HinTN
@Anonymous At Work: The perfect is the mortal enemy of the good enough.
Thanks, as always, for cutting through the fog David.
David Anderson
@Anonymous At Work: Simonistas for life — we ride at dawn
raven
I’m on medicare and an Anthem Medigap G plan but the prescription plans are a nightmare. Fortunately we have a retired stats professor who is a volunteer with the “Georgia SHIP” which provides free, unbiased information and assistance to Medicare beneficiaries and their caregivers with health and drug plans. and he’s been a great help.
Anonymous At Work
@David Anderson: Let them drive lemons (the cars, not the fruit).
TBone
My financial advisor offered to assist and, after the election, I’ma take him up on that offer! I abhor this chore! Gobbledygook jargon gives me the redass.
TBone
@raven: it’s really great to hear that!
TBone
@David Anderson: 💙 this is why I love BJ so very much. I learned a new word and concept of a plan today! 🤭 😉
https://en.m.wikipedia.org/wiki/Satisficing
Thank you for all that you do and contribute here.
West of the Rockies
Thank you for an informative and empathetic post, David.
Man, JC, you have assembled a group of crazy- knowledgeable personalities and writers here.
dnfree
@raven: I don’t know what kind of medications you take, but this year we went to one of those senior drug advisers. There are sufficient changes this year regarding maximum out of pocket that things have gotten very weird. The drug plan my husband and I were both on last year (we are not always on the same plan because our expensive medications are different) had zero premium but a high deductible and fairly high cost for our expensive drugs. This year that plan moved expensive drugs from one tier to another. Our best plan this year for combined cost (AARP) turns out to have a VERY high premium ($81 a month) but the drugs are cheaper.
The previous two years I was able to use the Medicare site myself to evaluate plans based on our medications, but this year it was very wonky. On one screen it would show a total cost of 0 (very unlikely) and then the detail screens would show different amounts on different tries. So I didn’t trust it.
eclare
I get my insurance through the ACA and have really used it this year to do some things that I had been postponing. I’m very pleased with it, Cigna, so I’m hoping there aren’t any big changes. Last year I just rolled over my Cigna plan.
TaMara
As, always, thanks David for your insights.
So much UGH this year. Premiums increased so much that I now need to shop for a different plan and on the rare year I may actually need a medical procedure, no one can tell me what plan will definitively cover it. Even the one I have now, which I would keep if they could give me an answer.
For-profit health insurance is morally and ethically wrong – not because I need it – but because I watch too many people put off care or have to spend time and energy that would be better spent on recovery trying to wade through insurance claims and jump through ridiculous hoops.
I’m watching my brother’s family drown in horrendous medical debt, even with “excellent” insurance because of a breast cancer diagnosis and treatment.
No one should die because of shareholder profits.
/rant
TBone
@TaMara: gentle hugs in solidarity
My best friends, a sweet couple, have only one son, who recently had a serious, disabling medical emergency and they now have to pay his mortgage and deal with hundreds of thousands in medical debt on his disabled behalf through GoFundMe. He just got married and bought the house last year, in his early thirties. 😭
ETA a palate cleanser, FEMALE STYLE:
https://www.attorneygeneral.gov/taking-action/ag-henry-sues-prospect-medical-holdings-over-breach-of-contract-mismanagement-of-crozer-health-system-resulting-in-closures-disruptions-of-services/
Kosh III
Thanks as always for the help!
I’m still searching, my employer plan ends February 28.
Y’all and others advise NOT to get Medicare Advantage but Cigna offers zero premium, Plan G has a premium and I’ve not even looked at fraking drug coverage. I am in good shape for 73–hiking tomorrow! but I take several bp and prostate meds as well as meds for neuropathy, arthritis and more. At least synthroid is cheap.
MY brother has Cigna MA and told me that it paid for everything for his wife who was in and out of the hospital for years. He said the bills were hundreds of thousands–I believe it.
So year, it’s a pain in the ass. Problems or not I’d love the US to have something like the UK, Canada, Denmark or wherever.
TBone
@Kosh III: F.Y.I. in decision making
https://insideinvestigator.org/blumenthal-releases-scathing-medicare-advantage-report/
DaBunny
@David Anderson: Ride…eh, sometime early morning anyway. Doesn’t have to be precisely at dawn, does it?
More seriously, our adult child was living in CO, on a Cigna ACA plan there. Lost job and used up unemployment benefit, so moving back with us (in IL). We already got the unpleasant surprise of learning that CO insurance doesn’t cover care in IL. Wondering what insurance to get in IL? Likely eligible for Medicaid?
Ann McClenahan
I’m in original Medicare and am looking at Medicare Advantage programs this year. I would LOVE it if David or any one of you could recommend navigators/assisters/brokers who do work in MA. I am feeling overwhelmed! Many thanks
Kayla Rudbek
@Scout211: the federal vision and dental plans are pretty good
Kosh III
Any navigator/assistant/whatever in Tenn to recommend.?
Sure Lurkalot
My current Medicare Part G provider didn’t inform me last year what my new premium amount would be until the end of November…leaving little time to price an alternate. I haven’t contacted them this year about 2025 premium amount but I plan to, still, this is not good. Do people not reprice their supplements…because of re-underwriting?
As for Part D, should you choose based on the drugs you use or worry about drugs you might need? Both my spouse and I have no daily prescriptions and what we do get is cheap. I’ve picked cheap plans and they’ve been just fine but what if we get some diagnosis as we age (seems inevitable)?
raven
@Ann McClenahan: Run away from the advantage plans , they can drop you whenever they want to. check out
https://www.youtube.com/@MedicareSchool?app=desktop
Scout211
If you mean for Medicare (and not ACA), here is the agency you contact to get an advisor/navigator in your area.
TN SHIP One-Pager
raven
@Ann McClenahan:
https://youtu.be/zSapJXULrok?feature=shared
A woman from anywhere (formerly Mohagan)
I called our health insurance broker last week for an appointment (I’ve used the company for decades), and was told because of a law passed in CA, brokers could not be paid a commission so they were not advising about health insurance for Medicare this year. So off to the Medicare.gov site for Part D (sigh). My husband’s plan has changed and dropped one of his (expensive) drugs. That’s as far as I have gotten. Hopefully this weekend will try to find a plan that covers it.
David Anderson
@DaBunny: with no income..Medicaid it would be
Okay we ride before 2nd breakfast
Ann McClenahan
@raven: Thanks so much. I just watched the video. For me, I now see it is a no-brainer to stay in Original/Supplemental Medicare. Super helpful.
dnfree
@A woman from anywhere (formerly Mohagan):
There are companies that specialize in Medicare coverage, and they’re free to the customer. The last two years I was able to do it myself for myself and my husband on the Medicare site, but this year it was really wonky and kept giving me different odd results (like telling me my total drug cost was 0). So I went back to the company we worked with a few years ago, and I explained above our results this year. I do not trust the Medicare site this year, but your results may vary.
dnfree
@Ann McClenahan:
I’ve said this before, but when we first went on Medicare I went to an Advantage presentation. The salesperson even said “IF you have known health issues and IF you can afford it, you are better off with traditional Medicare and a supplement plan.” We met both conditions and have been very glad. Advantage is a fine plan as long as nothing goes wrong, but their motivation is to save money. I also like that I can go to any doctor or facility in the country that takes Medicare, and I’m covered when traveling in the US.
sab
@Ann McClenahan: I am in original medicare plus supplemental. My husband went instead with medicare advantage from an insurance company with strong ties to one of our big local hospital chains.
My health issues so far are cardiac related, sudden onset type things, so I wanted medicare so that network wouldn’t be an issue if we were out of town. If I had a cardiac event in the US I would be covered.
My husband’s health issues are mostly orthopedic, so scheduled weeks or months in advance, and It seemed a good choice for him, since all of his doctors were in that network.
Then his hospital system decided to go for-profit, and most of his doctors left. The younger ones need to work for a non-profit by the terms of their student loans. The older ones were disgusted by the cutbacks in charity care.
So here he is, wondering about his future care, and no way to opt into medicare supplemental at this late date ( 73 with expensive pre-existing conditions.)
Chris T.
Sticking with my (expensive) gold-band plan because Ozempic and Jardiance alone cost about as much monthly. :-)
Had another kidney stone come out recently, as a total surprise because there was no pain first. Despite all my actual and potential issues, things are going well lately, ever since I got on some hormone replacement (for hormones apparently suppressed via Ozempic, which otherwise has done great things for A1c, I’m finally back in the “borderline pre-diabetic/diabetic” zone).