Medicare Enrollment Deadline Approaches

Today, December 7th, marks the final day for millions of seniors to select their Medicare plans for the upcoming year. Many are faced with the decision between traditional Medicare and Medicare Advantage, the latter being managed by private companies, which has some critics concerned.

For Americans reaching 65, enrolling in Medicare is a typical step. However, navigating the various options—like supplemental coverage, drug prices, and private plans—can be quite complex. Rick Cadeford, an independent insurance agent from Nebraska who works with Saving Seniors Money, helps seniors weigh their choices between traditional Medicare and Medicare Advantage plans.

Rick Cadeford: “We don’t push people in one direction. Our role is to educate and assist them in finding the coverage that suits their needs.”

Supplemental coverage under traditional Medicare, often called Medigap, can vary greatly in cost, with monthly premiums ranging from around $30 to over $600. Medicare Advantage plans frequently offer additional perks, like dental and vision coverage, and their low monthly premiums are a key appeal. This year, over half of Medicare beneficiaries—roughly 36 million—are enrolled in these Advantage plans, according to the Centers for Medicare and Medicaid Services. Jeremy Nordquist from the Nebraska Hospital Association points out that Advantage plans operate through certain networks, may include copayments, and often require prior authorizations for medical services. This can lead to treatment delays or overcrowding in hospitals.

Jeremy Nordquist: “If you think you’re going to be healthy, that’s fine. But, let’s be real—most seniors face healthcare needs, so it’s wise to consider these potential hurdles beforehand.”

Ivan Mitchell, CEO at Great Plains Health in central Nebraska, shares that claim denials from Advantage plans have led to doctors spending more time negotiating with insurance than with patients. His facility stopped accepting Medicare Advantage last year, noting challenges with scheduling and meeting patient needs.

Ivan Mitchell: “We have around 400 members, but we can’t accommodate them. They have to seek care elsewhere.”

This situation isn’t unique to Great Plains Health. According to Becker’s Hospital Review, around 40 healthcare systems in the U.S. have opted to drop at least one Medicare Advantage plan this year. The federal government allocates funds monthly to Advantage plan companies, which, as per the Medicare Payment Advisory Commission, has contributed to an $84 billion increase in overall Medicare expenditures this year. This trend irks critics like Mitchell.

Ivan Mitchell: “It feels like we’ve let commercial insurers tap into the Medicare Trust Fund, which is quite unethical, in my view.”

Mitchell argues that practices such as underpayment to health plans and burdensome paperwork from claim issues exacerbate the situation. On the other hand, the Better Medicare Alliance, a nonprofit advocacy group, contends that Medicare Advantage can deliver considerable value and choice for seniors. CEO Mary Beth Donahue notes that she has communicated with the Trump administration about steps to improve the claims process.

Mary Beth Donahue: “Delays are simply unacceptable. We’re implementing new rules and commitments to expedite decision-making.”

Meanwhile, Congress is considering a bipartisan bill aimed at making Medicare Advantage operations more transparent, intending to assist seniors when selecting health insurance in the future. This is Macy Byers reporting for NPR News from Lincoln, Nebraska.