Medicare enrollment: What you need to know without listening to Joe Namath in commercials

Medicare's annual open enrollment begins this month, giving seniors age 65 and older a chance to sign up for health care coverage for 2024 — and sit through a seemingly endless loop of television commercials touting the latest insurance product.

Medicare enrollees in New Jersey reviewing their options this year have a ton of choices, but it can make for a confusing time. Original Medicare or Medicare Advantage? Which Medicare Part D plan for prescription drugs should you pick?

"It's hearsay, it's going out to restaurants and talking to their friends" said Toby Stark of Stark Associates Insurance Agency in Tinton Falls. "It's just a ton of misinformation. And sometimes they act wrongly, and pick the wrong plan because of what a friend or Joe Namath or J.J. Walker told them."

The sheer amount of advertising is a sign that there is a lot of money at stake. In New Jersey, more than 1.7 million people are enrolled in traditional Medicare or privately administered Medicare Advantage.

COVID: More Jersey Shore hospitals bring back mask mandates; rules vary for different roles

Open enrollment lasts from Oct. 15 until Dec. 7. And it gets underway as the Biden administration touts provisions from the Inflation Reduction Act that are designed to slow down prescription drug costs for Medicare. Insulin has been capped at $35 a month. And this year, Medicare is slated to begin negotiating prices with drug makers for the first time on 10 widely used drugs. The negotiated prices are expected to take effect in 2026.

When he became eligible for Medicare, Howard Molen, 67, of Brick, one of Stark's clients, decided to keep it simple. He stuck with traditional Medicare and shops each year for a prescription plan to see where he can save money. And he tuned out the commercials pitching Medicare Advantage.

"When those commercials come on with Joe Namath or Sam Davis, they pound it into you 24/7," Molen said. "Either I'll change the channel or I'll put it on mute."

Decisions for retirement: Why Americans plan to take Social Security earlier, and even leave retirement money behind

Here's what you should know for open enrollment this fall:

How does original Medicare work?

Original Medicare consists of: Part A, which covers inpatient care in a hospital, skilled nursing facility care, hospice care and home health care; and Part B, which covers physician services and outpatient hospital services. Beneficiaries who choose original Medicare are eligible to enroll in Part D, which covers prescription drugs.

Patients with Medicare can go to any doctor or hospital in the United States. And they don't need a referral to see a specialist.

But the plan doesn't cover most dental, vision, hearing or routine physical exams.

The amount Medicare enrollees will pay in premiums (the monthly price of insurance) and deductibles (the amount paid out-of-pocket before insurance kicks in) hasn't fully been released. For Part A, 99% of beneficiaries last year had $0 premiums with an annual deductible of $1,600 for each inpatient hospital stay up to 60 days. For Part B, beneficiaries' premiums are based on their income, although most paid $164.90 a month with an annual deductible of $226.

The average total monthly Part D premium is projected to decrease from $56.49 in 2023 to $55.50 in 2024, due mainly to provisions from the Inflation Reduction Act.

Stark advises Medicare beneficiaries to shop for a prescription drug plan at Medicare.gov and purchase supplemental insurance, known as Medigap, to help cover out-of-pocket costs.

One note: When they initially enroll in Medicare, almost all beneficiaries are eligible for a Medigap policy with no health questions. If they choose Medicare Advantage and later decide to switch to original Medicare, their Medicare supplement policy can be turned down due to pre-existing conditions, Scott Hartung, president of Shore Benefits Brokerage in Allenhurst, said.

"Unless the cost of a Medicare supplement is prohibitive, I hate to see someone take an Advantage plan first and squander their free pass," Hartung said.

Painless brain surgery? Jersey Shore hospital's tumor-fighting machine makes it possible

How is Medicare Advantage different from original Medicare?

Medicare Advantage plans are administered by private insurance companies instead of the government, and they have made inroads. In 2023, 43% of Medicare beneficiaries in New Jersey had Advantage plans, lower than the national average of 51%, but up from 16% a decade ago, according to data from the Kaiser Family Foundation, a health care research group.

The plans cover hospital stays and doctors' visits. And many include coverage for prescription drugs, dental, vision and hearing.

They typically have lower premiums than original Medicare. The average monthly premium for 2024 will be $19.22, up 22.9% from 2023, according to the Centers for Medicare & Medicaid Services, although some plans have $0 premiums.

But the plans have networks of providers, so enrollees need to make sure their doctors and hospitals are included. And choosing a plan takes research. In Ocean and Monmouth counties, consumers can select among eight insurance companies offering a total of 40 or so plans, with potential out-of-pocket costs varying widely.

Medical care: These Jersey Shore towns desperately need doctors, so here's what they're doing

Didn't Joe Namath retire a long time ago?

Consumers during Medicare's open enrollment are inundated with ads. During a nine-week stretch in the fall of 2022, health insurers, brokers and marketers aired nearly 650,000 ads nationwide, or more than 9,500 a day, the Kaiser Family Foundation said in a study released recently.

TV ads for Medicare Advantage accounted for 85% of them. And Joe Namath, the Hall of Fame quarterback from the New York Jets, who retired after the 1977 season, has been Medicare Advantage's biggest spokesman: He was featured in nearly 56,000 ads, more than any other celebrity, Kaiser Family Foundation said.

Meanwhile, the Centers for Medicare & Medicaid Services saw beneficiary complaints — largely about brokers and other third-party marketing organizations using aggressive sales tactics and misleading claims — rise from 15,497 in 2020 to 39,617 in 2021, excluding December, Kaiser Family Foundation said.

The next year, Kaiser Family Foundation conducted focus groups and found beneficiaries were often overwhelmed by the volume and complexity of choices. And few took advantage of free resources such as the Medicare Handbook or 1-800-Medicare.

Inflation: How will your Social Security COLA change in 2024? Think smaller.

CMS has rolled out new rules designed to regulate advertising. Among them: Advertisers can't use the Medicare name or CMS logo in a misleading way; they can't make unsubstantiated claims; they can't advertise benefits that aren't available in a particular service area.

"While beneficiaries may appreciate the ability to select from multiple options, the variable costs, benefits, provider networks and other characteristics of Medicare Advantage plans make the decision complex, especially in light of the barrage of advertising," Kaiser Family Foundation said in its report. "Additionally, information about coverage under traditional Medicare is rarely included in television ads, leaving beneficiaries with an incomplete view of their coverage options and the tradeoffs among them."

Michael L. Diamond is a business reporter who has been writing about the New Jersey economy and health care industry for more than 20 years. He can be reached at mdiamond@gannettnj.com.

This article originally appeared on Asbury Park Press: Medicare open enrollment: How it works and what you need to know