Shopping season for Medicare coverage is about to begin. With it comes the annual onslaught of TV ads and choices to consider.
People eligible for the federal government’s Medicare program will have from Oct. 15 to Dec. 7 to sign up for 2025 Medicare Advantage plans, which are privately run versions of the program. They also can add a prescription drug plan to traditional Medicare coverage.
Many people on Medicare Advantage plans will probably have to find new coverage as major insurers cut costs and pull back from markets. Industry experts also predict some price increases for Medicare prescription drug plans.
A UnitedHealthcare Group Medicare Advantage PPO card rests on top of a Medicare card is seen in Portland, Ore., June 10, 2024.
Shoppers often have dozens of options during this sign-up period. Here are some things to consider.
Don't put off shopping for Medicare coverage
Start thinking about next year's coverage before the annual enrollment window begins. Insurers will usually preview their offerings or let customers know about any big changes. That makes anything arriving in the mail from your insurer important to read.
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Insurance agents say many people wait until after Thanksgiving to decide coverage plans for the new year. That could be a mistake this year: The holiday falls on Nov. 28, leaving slightly more than a week to decide before the enrollment window closes.
Look beyond the premium
Many Medicare Advantage plans promote a $0 premium. That may sound attractive, but price is only one variable to consider.
Shoppers should look at whether their doctors are in the plan’s coverage network and how prescriptions would be covered. They also should know the maximum amount under the plan that they’d have to pay if a serious health issue emerges.
Plans offer many supplemental benefits, including help paying food or utility bills. Don’t let those distract from understanding the core coverage, said Danielle Roberts, co-founder of the Fort Worth, Texas, insurance agency Boomer Benefits.
“Remember that we buy health insurance for the big things, not the frills,” she said.
How to get help shopping for plans
The federal government operates a plan finder that lets people compare options. The State Health Insurance Assistance Program can be another resource. Insurance brokers or agents also guide customers through searches.
Sometimes a plan’s coverage doesn’t work as expected. If that happens, there’s another enrollment window in the first three months of each year where some shoppers may be able to make a change.
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Have Medicare? You may be able to get better access to mental health care this year
Expanding billing eligibility
Family therapists and mental health counselors can bill Medicare directly due to the reforms implemented this year.
CMS will temporarily add health and well-being coaches to covered services under its Medicare Telehealth Services list this year. It's also expanding the health care providers that provide covered behavioral health assessments to provide better physical care. It will begin allowing addiction, drug, and alcohol counselors who meet certain requirements to enroll as mental health counselors under Medicare.
CMS also plans to add a rule this year that allows health providers to pay for caregiver training through Medicare, hoping to expand and enhance the existing caregiving industry.
Addressing rural health care deserts
This year, CMS will reduce requirements for nurse practitioners, allowing them to provide behavioral health services at rural health clinics and federally qualified health centers. Previously, they had to have certification in providing primary care, but CMS is removing the barrier in order to alleviate staffing shortages. It will also allow those clinics to continue providing telehealth services.
Expanded opioid treatment coverage
As part of its expansion of COVID-era telehealth policies, CMS is also extending a temporary rule that allows Opioid Treatment Programs to bill Medicare for assessments of patients conducted over the phone or online using audio only and no video. With this move, CMS hopes to avoid disruptions to existing access Medicare recipients have to opioid treatment.
Including community health workers and peer support specialists
Medicare will now allow for the reimbursement of services from more health care specialists, expanding the possible avenues for treatment in places where they might be hard to find.
The new reforms specifically include peer support specialists and community health workers. Peer support specialists help others avoid relapse and maintain their recovery process, a relationship informed by the specialist's lived experiences with conditions like substance use disorder. Community health workers help connect the health care system with the communities they serve.
CHWs work at nonprofits, government agencies, public health departments, and community programs. They can perform educational outreach, counseling, or help people find transportation to appointments. These kinds of workers were integral to the public health response to the COVID-19 pandemic: Studies found CHWs offer support for geriatric patients with complex needs, according to a research review published in a 2022 issue of the Journal of the American Geriatrics Society.
Some states were already making rules to allow for coverage of CHW services, and new Medicaid rules may also expand the number of working CHWs around the country as funding for them is bolstered.
Story editing by Alizah Salario. Copy editing by Kristen Wegrzyn. Photo selection by Lacy Kerrick.
This story originally appeared on Foothold Technology and was produced and distributed in partnership with Stacker Studio.
