Each fall, Medicare seniors can sign up for, change or disenroll from a health plan for the following year. Yet, despite having more options than ever, research shows that most people choose the wrong health plan, often paying more than they need to.

Calyx Health, a doctor’s office exclusively for Medicare seniors in Alameda, analyzed its patients’ secondary insurances (Medigap, Medicare Advantage, Prescription Drug Plans) and found some alarming results:

• One in three seniors is underinsured and thus a hospital stay away from financial ruin.
• One in four seniors is overpaying by an average of $1,177 or more per year for the same benefits — some as much as $2,388 per year.
• One in five seniors is dual eligible (Medicare and Medi-Cal) and can access expanded benefits under new 2019 plans.

In total, the analysis found that almost 80 percent of Alameda seniors would benefit from a different Medicare plan in 2019. Though these statistics are alarming, they are not surprising. Choosing the right Medicare plan can be challenging. 

For starters, insurance jargon such as “co-insurance,” “deductibles” and “donut hole,” can be difficult to grasp and confusing. Even when one is savvy enough to understand these terms, it can be technically difficult to calculate the true annual costs associated with each plan, taking into consideration doctor co-pays, prescriptions, labs and procedures. The plan with the lowest monthly premium is not always the cheapest overall.

And finally, plans prices and benefits change every year. Reassessing the best plan to fit one’s needs should be an annual activity, though most seniors tend to stay on the same plan despite increasing costs. Insurers have been known to exploit this behavior with “invest, then harvest” strategies, where prices are intentionally low initially but escalate more rapidly over time. 

Before purchasing anything, including healthcare, it’s important to do some research. Given the complexity involved in choosing the right health plan, the recently launched Calyx Advantage offers free consultations to help people find a Medicare plan that meets their needs and budget. The Medicare annual enrollment period is Monday, Oct. 15, through Friday, Dec. 7, and is a good time to review options.