A new report highlights the substantial difficulties that many older adults face in enrolling in Medicare, and calls for new steps to simplify and streamline the process.
The report—titled Medicare Part B Enrollment: Pitfalls, Problems and Penalties—is the work of the Medicare Rights Center, a New York-based nonprofit group. The report notes that enrollment problems can have serious consequences for retirees: Beneficiaries new to Medicare, according to the center, “may face lifetime late-enrollment penalties, higher health care costs, gaps in coverage and disruptions in care continuity.”
The study notes that about 10,000 Americans turn 65 and become Medicare-eligible each day. Many of these individuals, including those already receiving Social Security benefits, are automatically enrolled in Medicare Parts A and B, which cover hospital care and doctors’ services, respectively.
But individuals who navigate Medicare enrollment on their own frequently struggle with the mechanics, including enrollment periods, the coordination of benefits rules and penalties associated with delayed enrollment.
A “perfect storm [is] brewing,” says Joe Baker, president of the center. The combination, he says, of an aging population and more Americans who are working beyond age 65—and delaying Social Security benefits—means more individuals are likely to encounter problems with Medicare enrollment.
The center notes that in 2013 it fielded more than 15,000 questions on its national helpline (800-333-4114). More than one in five (22%) involved enrollment. Of those, nearly one-quarter were from individuals grappling with enrolling in Part B. Among those, 38% had difficulties navigating a specific hurdle, 28% didn’t understand enrollment periods, and 13% weren’t sure whether they were Medicare-eligible. Many callers, the report adds, don’t understand how Medicare coordinates with their existing health coverage.
Despite these challenges, many beneficiaries who err in the enrollment process have limited recourse to “equitable relief.” That process allows individuals to request immediate or retroactive enrollment into Part B and the elimination of late-enrollment penalties. But such relief is granted only to people who can prove they received misinformation from a federal source before enrolling in Medicare.
How best to tackle these issues? The Medicare Rights Center recommends:
Enhanced education. Both federal agencies and employers need to develop materials to notify people nearing Medicare eligibility about what steps to take and when. Currently, “no federal entity is responsible” for alerting would-be beneficiaries about the process, says Baker.
Changes in enrollment periods. The Initial Enrollment Period for Medicare and the General Enrollment Period, which runs from January through March, should be reformed and simplified—“particularly by ensuring that Medicare coverage begins as quickly as possible,” the report states.
Stronger avenues for relief. In short, many people simply make honest mistakes when enrolling in Medicare. Given that fact, access to equitable relief and special enrollment periods should be more readily available, the center argues.
Additional research. More studies are needed, according to the center, to determine how many people are affected—and will be affected—by enrollment issues.
“Without solutions,” the report concludes, “a growing share of newly eligible beneficiaries will experience the harsh consequences of mismanaged transitions, risking their health and financial security.”