How to Navigate Medicare's Open Enrollment

Summary

Podcast Summary: WSJ Your Money Briefing — “How to Navigate Medicare's Open Enrollment” (November 12, 2020)

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Episode Overview

This episode of WSJ Your Money Briefing focuses on practical strategies and considerations for Americans navigating Medicare’s yearly open enrollment period (through December 7th). Host J.R. Whalen interviews Wall Street Journal retirement reporter Ann Tergeson, who also shares her personal experience assisting her father with Medicare decisions. The conversation unpacks the complexity of Medicare choices, practical tools for comparing plans, advice on involving doctors, and the importance of annual plan reviews.

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Key Discussion Points & Insights

The Overwhelming Array of Choices

• Open Enrollment Context:
  Over 54 million older Americans are choosing their Medicare coverage amid a health crisis. (00:35)

• Sheer Number of Options:

  • Ann notes her father had 60–70 different options just within his county, highlighting the complexity facing many enrollees. (02:00)
  • The decision extends beyond just different insurers—it includes various plan types and features.

    “There just are so many options...He himself has over 60 options, I think it’s actually 70 in the county where he lives.” — Ann Tergeson (02:03)

Traditional Medicare vs. Medicare Advantage

• Traditional Medicare:

  • Fee-for-service model, covering about 80% of doctor costs.
  • Most people need to add a supplemental “Medigap” plan to cover remaining costs, and also a Part D prescription plan. (02:42)

• Medicare Advantage (MA) Plans:

  • “All-in-one” managed plans; include medical and prescription coverage, mirror the structure of employer plans with insurer networks (Aetna, Cigna, etc.).
  • In-network care is usually covered better than out-of-network. (03:19)

    “They include prescription drugs and medical coverage and they work kind of like what we’re familiar with with our employer-sponsored plans...and you get higher coverage for going in network than out of network.” — Ann Tergeson (03:20)

How to Compare Medicare Plans

• Get Free Help:

  • Ann strongly recommends reaching out for free guidance, via the State Health Insurance Assistance Program (SHIP) or local nonprofits familiar with Medicare. (03:51)

    “I would highly recommend trying to get some free help from your state SHIP program...that’s really kind of a good first step.” — Ann Tergeson (03:52)

• Government Tools:

  • Use Medicare’s Plan Finder tool at Medicare.gov.
  • For current enrollees, the tool pre-populates with prescription and claims data, allowing personalized cost comparisons. (04:19)
  • The Plan Finder presents out-of-pocket costs for different scenarios, including “worst case” maximums.

    “The great thing is that it pre-populates that account with your claims data, so you don’t have to manually enter...It uses that information to...search in a personalized way for how much all the plans available to you are going to cost.” — Ann Tergeson (04:29)

Pitfalls and Verifying Coverage

• Call Your Providers:
  • Ann stresses contacting every doctor, hospital, and rehab provider you want access to; verify which plans they currently accept. (05:08)
  • Even within the same office, information may conflict—always call and double-check rather than relying on emails or assumptions.

    “I got conflicting information even from one doctor’s office. So it’s important to call, ask and verify.” — Ann Tergeson (05:55)

Deciding Between Low Premiums vs. Lower Out-of-Pocket

• Look Beyond the Premium:
  • Choosing a plan solely based on lowest premiums can be risky if the out-of-pocket maximum is high (e.g., $12,000/year). (06:32)
  • Ann urges users to always consider the “all-inclusive cost” using the tools offered.

    “I think a lot of people...just look for the one with the lowest premium. But you really shouldn’t do that. You really have to be careful and try to look at some kind of all-inclusive cost.” — Ann Tergeson (06:34)

Why You Should Review Your Medicare Plan Annually

• Frequent Changes:
  • Doctors and hospitals may change which plans they accept from year to year.
  • Benefits, out-of-pocket maximums, and copays within plans can also shift. (07:30)
  • Relying on last year's plan may leave gaps in coverage or result in higher unexpected costs.

    “A doctor who takes a certain Medicare Advantage plan one year may not take it the next...You need to know from year to year, how are the benefits changing?” — Ann Tergeson (07:31)

Preparing for the Unexpected

• Focus on the Out-of-Pocket Maximum:

  • Since future medical needs are unpredictable, Ann (and her consulted expert) recommend using a plan’s out-of-pocket maximum as your key comparison metric. (08:13)
  • Even healthy individuals need to prepare for the “worst-case scenario.”

    “I think that out-of-pocket maximum is the key.” — Ann Tergeson (08:32)

• Annual Review Is a Good Habit:

  • Ann confirms she’ll likely repeat this process with her father again next year, emphasizing the importance of annual plan review. (08:54)

    “I think the answer is that we definitely should be doing it next year. So we probably will.” — Ann Tergeson (08:54)

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Notable Quotes & Memorable Moments

• On the complexity and frustration:

  “I think a lot of people just...kind of throw up your hands and say let’s just forget about that. We’ll just look for the one with the lowest premium. But you really shouldn’t do that.” — Ann Tergeson (00:56, 06:34)

• On conflicting information:

  “I got conflicting information even from one doctor’s office. So it’s important to call, ask and verify.” — Ann Tergeson (05:55)

• On tools and assistance:

  “I would highly recommend trying to get some free help from your state SHIP program...that’s really kind of a good first step.” — Ann Tergeson (03:52)

• On preparing for the unforeseen:

  “Even healthy individuals need to prepare for the ‘worst-case scenario.’ I think that out-of-pocket maximum is the key.” — Ann Tergeson (08:32)

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Important Timestamps

• 00:35 — Overview of Medicare open enrollment statistics and context
• 02:00 — Ann’s personal story helping her father
• 02:42 / 03:19 — Explanation of Traditional Medicare versus Medicare Advantage
• 03:51 — Where to find free help (SHIP, Plan Finder tool)
• 05:08 — Verifying coverage with doctors and providers
• 06:32 — The full-cost calculation (premiums vs. out-of-pocket)
• 07:30 — Why reviewing your plan every year matters
• 08:13 — Focus on out-of-pocket maximums for future unpredictability

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Summary Takeaway

Medicare’s open enrollment is tricky, and both seasoned and new enrollees can easily become overwhelmed. The key is to use all available resources—especially free, neutral advisors and official online tools—to review not just premiums, but the all-in cost and provider compatibility, and to repeat this evaluation every year. Ann Tergeson’s personal and professional experience highlights the value in verifying all details and anticipating life’s uncertainties when choosing a plan.

Transcript

[Deel Representative]

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[J.R. Whalen]

Here's your money briefing for Thursday, November 12th. I'm J.R. whelan for the Wall Street Journal. 54 million older Americans are currently signing up for next year's Medicare coverage through open enrollment, which runs through December 7th. With dozens of choices available in the country, in the middle of a health crisis, seniors need to be extra careful in choosing the right plan.

[Ann Tergeson]

It's really hard. I think a lot of people just, you know, when you see like the copays and the deductibles and there's so many different ones for different circumstances, you kind of throw up your hands and say, let's just forget about that. We'll just, we'll just look for the one with the lowest premium. But you really shouldn't do that. You really have to be careful and try to look at some kind of all inclusive cost.

[J.R. Whalen]

Our retirement reporter, Ann Tergeson says there are some key questions to ask your doctor and will tell us about her own experience in helping her father sign up for Medicare benefits. That's after the break. Medicare open enrollment runs through December 7th. And as millions of older Americans choose their Medicare coverage for next year, understanding the maze of costs and benefits can be tricky. Our retirement reporter, Ann Tergeson has been navigating the signup process for her own family members and joins us now. Ann, thanks for being here.

[Ann Tergeson]

Sure.

[J.R. Whalen]

So you know, there are dozens of Medicare coverage choices available and it's not easy to navigate this stuff. You've been helping your father with this. How's that going?

[Ann Tergeson]

So he was already signed up for Medicare and he had, he's been on Medicare for a while, but we, for a variety of reasons, he had to think about whether to make a change or not. And he, there just are so many options. I mean, he himself has over 60 options. I think it's actually 70 in the county where he lives. And it wasn't only a choice between a certain type of Medicare plan. There were a couple different types of Medicare plans he had to choose between. So he asked me for my help because he knew that I have done a lot of articles about Medicare and that I understand the system. And he's been on one type of plan for years and wasn't really familiar with the alternatives.

[J.R. Whalen]

So how did you sort through all the options?

[Ann Tergeson]

So Medicare's a little bit complicated actually. So you have on the one hand traditional Medicare, which is the traditional fee for service Medicare. If you go that path, Medicare, usually It pays about 80% of like doctors costs. It doesn't cover 100% of the costs. So most people will want to buy a supplemental plan that covers the medical costs that Medicare doesn't cover. And generally those are Medigap plans. And they also generally want to buy a part D prescription drug plan to cover their prescription medications. So that's traditional Medicare. You can bypass that whole thing and go with what's called a Medicare Advantage plan. These are sort of all in one plans. They include prescription drugs and medical coverage and they work kind of like what we're familiar with with our employer sponsored plans where it's covered by an insurer like Aetna or Cigna or United Healthcare and they have an in network group of doctors and you get higher coverage for going in network than out of network. So you've got on the one hand traditional Medicare and on the other hand you have Medicare Advantage.

[J.R. Whalen]

What kind of tools did you use to compare costs?

[Ann Tergeson]

So first of all, I would highly recommend trying to get some free help from your state ship program, state health Insurance Assistance program. So we were lucky. We got some free assistance from a nonprofit that helps with people with Medicare claims denials. But they helped us because I have spoken with them in the past and they were willing to volunteer to help us. So I think getting free help is really kind of a good first step. The other tool that the person who helped us pointed us to is something called Plan Finder that's [e-mail] so you can go to Medicare.gov and if you're, you know, you're already in the system, if you've already been claiming Medicare, you just sign up for an online account. And the great thing is that it pre populates that account with your claims data so you don't have to manually enter, you know, what prescription medications you take. It just pulls all that from your claims data, which is great. And then it uses that information to search in a personalized way for how much all the plans available to you are going to cost given your medications that you take and your claims history.

[J.R. Whalen]

Now what are some of the pitfalls that people should be watching for as they compare coverage?

[Ann Tergeson]

So one thing that I was really surprised about is that it's really important to call. I think as a first step really is call all of your doctors who you want to keep and also call any hospitals that you know. If God forbid, something happened and you had to go to the hospital, which, which one would you choose to go to? And likewise, if you ended up needing to go to a rehab place, which one would you choose to go to? Call all of those places, find out. Do they take Medicare? Almost all of them probably will, but some doctors don't. So ask and find out what Medicare Advantage plans they take in network. That's really important. And actually when I called one of my father's doctors, I had emailed their business office and didn't get a reply. So I just picked up the phone. When I called, they told me one answer. They said, no, we don't take that coverage, that Medicare Advantage plan that you have in mind. But the business office said, yes, we do take it. So at the end of the day I got conflicting information even from one doctor's office. So it's important to call, ask and verify.

[J.R. Whalen]

You know the big question I think a lot of people have is, is it better to go for a lower monthly premium and higher co pays and deductibles or pay for a monthly plan and less out of pocket? So what factors should they be considering to make that choice?

[Ann Tergeson]

It's really hard. I think a lot of people just, you know, when you see like the copays and the deductibles and there's so many different ones for different circumstances, you kind of throw up your hands and say let's just forget about that. We'll just look for the one with the lowest premium. But you really shouldn't do that. You really have to be careful and try to look at some kind of all inclusive cost. And that's where that plan finder tool can be very helpful because it has different ways of presenting your potential out of pocket costs. In the case of drugs or in the case of medical care, it can give you out of pocket maximums that give you sort of a worst case scenario. And it's important because you know, you might get a zero premium Medicare Advantage plan, that sounds great, but if it has a $12,000 annual out of pocket maximum, then you end up in a year where you need a lot of care and you end up in the hospital. You kind of want to know ahead of time.

[J.R. Whalen]

Now, a lot of people already have a plan. Is there any reason they should not just stick with what they've got?

[Ann Tergeson]

Well, I think the reason why you shouldn't stick with what you got. Is that with Medicare Advantage there can be a lot of changes from year to year. You know, a doctor who takes a certain Medicare Advantage plan one year may not take it the next. That plan also can change what it provides in terms of, you know, the benefits. It can say, well, instead of charging you a very small copay, if you need dialysis, we're going to make you pay 20% of the total cost. So you need to know from year to year, how are the benefits changing? Is the out of pocket maximum going up or down? And you need to know, is my doctor still in this network?

[J.R. Whalen]

How can people get past the dilemma of not knowing how much medical care they're going to need during the year?

[Ann Tergeson]

Yeah, that's a tough one. So the person who I consulted with was very helpful in that regard. And basically what she recommended with medical care is looking at the out of pocket maximums. You know, how much in a worst case scenario is this plan gonna make me pay? So you can compare different plans that way. And it is like you said, it is very hard to know on a going forward basis how much medical costs you're gonna need. I mean, you might know, hey, you know, typically I'm super healthy, I hardly even see the doctor. But something could happen and you could be liable for a lot of costs. So I think that out of pocket maximum is the key.

[J.R. Whalen]

And you know, costs can fluctuate year to year. Will you be doing this again next year with your father?

[Ann Tergeson]

I think the answer is that we definitely should be doing it next year. So we, we probably will. It's probably a good idea.

[J.R. Whalen]

All right. That's Wall Street Journal retirement reporter Ann Tergeson. Ann, thanks for coming on the show.

[Ann Tergeson]

You're welcome.

[J.R. Whalen]

And that's yous Money briefing. I'm J.R. whalen for the Wall Street Journal.

[Deel Representative]

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