Many Local Seniors Pay Too Much for Medicare


Dr. Abhas Gupta

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 is a doctor’s office exclusively for Medicare seniors in Alameda. We did an analysis of our patients’ secondary insurances (i.e., Medigap, Medicare Advantage, Prescription Drug Plans) and found some alarming results:

·       1 in 3 seniors is underinsured and thus a hospital stay away from financial ruin

·       1 in 4 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

·       1 in 5 seniors is dual eligible (Medicare & Medi-Cal) and can access expanded benefits under new 2019 plans

 In total, our analysis found that almost 80% 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 plan 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 escalated more rapidly over time.

Before purchasing anything, including healthcare, it’s important to do your research. But you don’t have to do it alone. Given the complexity involved in choosing the right health plan, we recently launched Calyx Advantage—which offers free consultations to help people find a Medicare plan that meets their needs and budget. With the Medicare Annual Enrollment Period right around the corner (October 15th to December 7th), we encourage all Medicare beneficiaries to review their insurance options. You may be surprised by what you find.

 Calyx Advantage, a health insurance agency exclusively for Medicare plans, is located in the Alameda South Shore Center. To schedule a FREE consultation, call 475-0515 or click here.

Shaily Gupta