Medicare Is a Maze. How to Find Help During Enrollment Season.

Open enrollment in Medicare runs from Oct. 15 through Dec. 7. (Dreamstime)

Key Points

• Medicare open enrollment runs from Oct. 15 through Dec. 7, allowing beneficiaries to switch between traditional Medicare and Medicare Advantage.
• About 3.1 million people are in Medicare Advantage drug and special needs plans that are ending or leaving their county for 2027.
• About 1.2 million people are enrolled in stand-alone Part D plans that are ending, according to an analysis of government data by i65.

For Medicare recipients, open enrollment is a high-stakes headache every fall. Help is available to navigate your options, but it pays to understand where it’s coming from.

The big choice in Medicare is between traditional, government-run Medicare (plus an optional Part D drug plan and Medigap supplement plan) or Medicare Advantage, the privately run alternative. From Oct. 15 through Dec. 7, Medicare beneficiaries can switch between the two programs, switch from one Medicare Advantage plan to another, or pick a new stand-alone Part D plan to sit alongside traditional Medicare. Medigap isn’t part of open enrollment.

Those who do nothing are generally re-enrolled in their existing coverage. However, plans change out-of-pocket costs and other key features from year to year, so make sure your existing coverage is still your best option.

Disruptions will force some members into the market: About 3.1 million people with Medicare Advantage drug and special-needs coverage are in a plan that is ending or leaving their county for 2027 and won’t be automatically moved to another plan, according to an analysis of government data by Duos, a platform that helps beneficiaries navigate their benefits. What’s more, about 1.2 million people are enrolled in stand-alone Part D plans that are ending, according to an analysis of government data by i65, a Medicare consultancy.

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A good place to start is by comparing your options on the Plan Finder tool on Medicare.gov. (Similar-sounding commercial enterprises ending with .com shouldn’t be confused with the official government site.)

Plans might look the same on the surface, but the devil is in details like copayments, deductibles, and covered drugs. Here’s where you can turn to for help.

Medicare Brokers

An independent Medicare broker found via word-of-mouth or a site like MedicareAgentsHub.com can walk you through your options and provide valuable insights on the local market.

Consumers generally don’t pay brokers for their services. Instead, insurance carriers pay them a commission for enrolling members. The Centers for Medicare and Medicaid Services sets an annual cap on commissions for Medicare Advantage plans and stand-alone Part D plans.

In a focus group several years ago, most Medicare brokers reported receiving higher commissions for enrolling people in Medicare Advantage plans compared with Medigap supplement plans, according to the Commonwealth Fund, a foundation dedicated to healthcare quality. Even factoring in commissions for stand-alone Part D drug plans, many brokers made more enrolling people in Advantage.

The difference might be even wider today, since many insurance carriers have stopped paying commissions on stand-alone Part D plans, essentially rendering Part D advice pro bono on the part of brokers who provide it, says Melinda Caughill, co-founder of i65 and HeyMOE, an independent, fee-only provider of Medicare planning.

These financial pressures are real, but a good broker will take time to explain all options. Consumers can do their part by doing research beforehand and coming to the meeting with questions.

Fee-Only Advice

Some Medicare consultants charge a flat fee for individualized Medicare advice. The pitch is this payment model frees them from any financial incentive to steer clients toward one plan or another. i65, for example, offers a range of options starting at $199 for a Part D plan review for an individual. Choosing the right plan can save members hundreds if not thousands a year, based on their individual needs.

Free Resources

One source of free, unbiased Medicare guidance is through the State Health Insurance Assistance Program, or SHIP. These appointments tend to fill up fast, so don’t delay.

Consumers might be tempted to ask an artificial-intelligence chatbot for their best option, yet large language models often trip up over Medicare’s complexities, says Caughill, who routinely tests them. Experts also caution against putting sensitive personal information into chatbots.

AI-powered solutions specifically created for Medicare may be a better bet. MatchYourMedicare is a free, HIPAA-compliant informational tool to help seniors find the best Medicare plan for their individual needs; it’s an offshoot of careCycle, a Y Combinator-backed AI agent suite for Medicare agencies.

Write to Elizabeth O’Brien at elizabeth.obrien@barrons.com

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