Things to consider during the government shutdown

Medicare open enrollment began Oct. 15, but there’s one difference worth noting for beneficiaries looking to renew their health insurance plans. That means the federal government has been shut down since October 1st.

Updates related to Medicare Open Enrollment (through Dec. 7) will continue during the government shutdown, according to the Centers for Medicare and Medicaid Services.

Philip Moeller, author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, suggests holding off on finalizing coverage for 2026 until the government reopens, as the federal government shutdown could affect access to timely information.

“I urge people to wait to make decisions about next year’s coverage,” Mueller said.

Mueller said any changes made on the last day of public bidding will take effect from Jan. 1.

“Decisions should not be made in haste,” he said.

Now, until Dec. 7, Medicare beneficiaries can change their coverage. These options depend on your current enrollment status: whether you have Original Medicare, which typically includes Part A hospital insurance and Part B medical insurance, or whether you have Medicare Advantage, which is a private plan approved by Medicare.

During this period, beneficiaries can switch from Original Medicare to Medicare Advantage or vice versa, change Medicare Advantage plans, or find new Medicare Part D prescription coverage if they have Original Medicare.

Medicare beneficiaries may be tempted to set it and forget it when it comes to their existing plans. But Juliette Cubansky, associate director of KFF’s Medicare policy program, says it’s wise to assess how much coverage may change next year that could affect your out-of-pocket costs, especially with regard to preferred doctors and required medications.

A recent KFF study found that out-of-pocket medical expenses by Medicare beneficiaries averaged 39% of per capita Social Security income in 2022.

“Open enrollment provides an opportunity for people to evaluate their current coverage and other options in their area to see if they can get a better deal,” Cubanski said.

Some Medicare providers are expanding in certain markets, while others are exiting or exiting some regions, Mueller said. “It’s especially important this year that people do their homework,” he says.

The federal government shutdown “may not have a significant impact” on Medicare’s open offering, Cubansky said.

People trying to contact 1-800-Medicare to sort out their coverage options may experience some delays, Cubanski said.

Other resources are still open, she said, including Medicare’s Plan Finder portal, Medicare Advantage and drug plans, and Medigap carriers.

But the shutdown could make it more difficult to get concrete answers to questions about Planfinder information, Mueller said. He said staffing shortages could cause delays in using 800 Medicare numbers.

Medicare.gov, a website run by the Centers for Medicare and Medicaid Services, states that “mission-critical activities and updates related to Medicare Open Enrollment will continue during the government shutdown.” The agency did not respond to a request for further comment by press time on how the closure could affect open enrollment.

Because of these potential information restrictions, Mueller said he urged people to wait for a decision on next year’s coverage.

As Medicare beneficiaries consider whether to choose Original Medicare or private coverage with an Advantage plan, experts say it’s worth weighing the pros and cons.

Medicare Advantage plans are typically available at no additional premiums beyond Medicare Part B premiums, while also offering many additional benefits, Cubansky said.

But while Advantage plans may offer dental benefits, for example, it’s important to understand exactly what they include, she says. Does this include just annual cleanings, or does it cover a broader scope, such as bi-annual cleanings or dentures?

Indeed, Medicare Advantage typically limits access to certain services and providers, Cubansky said. Additionally, these private plans have more prior authorization requirements, which can impact access to care, she said.

Meanwhile, traditional Medicare is “becoming increasingly unaffordable” for some beneficiaries, Cubansky said. Individuals who require many medical services may face higher costs with traditional Medicare insurance, she said.

Additionally, unlike Medicare Advantage, traditional Medicare has no out-of-pocket caps on medical services, Cubansky said.

For more information on Medicare Advantage plans, Mueller said beneficiaries will be able to purchase plans this year. He said Medicare’s plan finder will include more details about additional benefits offered by Advantage plans, such as vision, hearing and dental.

Prospective Advantage enrollees will also have access to detailed information about doctors, hospitals and other health care providers in the plan provider network. Moller said this information will primarily be available on insurance websites.

There may be “some problems” with the newly available information, Mueller said, and beneficiaries may get a chance to start over with open enrollment in Medicare Advantage. Open enrollment for Medicare Advantage runs from January 1st to March 31st.

Beneficiaries covered by Original Medicare plans have the option of purchasing Medicare Part D to cover prescription drugs. If you have Medicare Advantage, you may be able to take advantage of these benefits through your private plan.

Either way, it’s important to review your choices next year to see if your prescriptions will be covered.

“If a plan doesn’t cover all of your prescription drugs, I’ll take it off the list,” Mueller said. “We want to make sure the plan covers all medications.”

Moller says there are also a number of non-premium Part D plans available, which can help lower your monthly expenses. But annual deductibles for these plans are trending upward, he said. He said out-of-pocket costs could also move to higher tiers.

“We must not lose sight of the fact that the primary basis for decisions is the overall annual cost,” Moller said.

In particular, while more zero-premium Part D plans are becoming available in some regions, the total number of plans overall is decreasing, Cubansky said.

The annual out-of-pocket limit for Part D drugs will increase from $2,000 in 2025 to $2,100 in 2026. Notably, that cap applies only to prescription drugs covered by the plan, Cubansky said. So, if you pay for a particular treatment outside of your plan, it won’t count toward the $2,100 out-of-pocket limit, she said.

“It’s always beneficial to shop around because you never know what you’re going to leave on the table,” Kubanksi says. “It may be that your current plan no longer provides the best coverage at the lowest cost.”