Medicare open enrollment is coming. Hospitals shouldn’t sit this one out.

Medicare open enrollment is coming. And this year, hospitals and health systems have a bigger role to play than most realize.

For 2027, beneficiaries may have a powerful financial reason to consider Medicare Advantage. CMS has ended a temporary premium stabilization program for standalone Part D prescription drug plans, and the Part D base beneficiary premium is increasing.

For seniors comparing monthly costs, Medicare Advantage plans that include prescription drug coverage may look increasingly attractive – especially given inflation and fixed incomes. The problem is that the premium is only one part of the decision. And it may be the least consequential part if you actually need care.

Across the country, hospitals, health systems, and physician groups have been reconsidering their participation in Medicare Advantage plans. Some have terminated specific contracts because of administrative burden, payment issues, prior authorization requirements, and denials. Others are evaluating whether their current arrangements remain sustainable. At the same time, insurers themselves are reducing Medicare Advantage offerings or leaving certain markets.

That creates an unusually complicated open enrollment season. Millions of people will be choosing coverage while the plans and provider networks behind that coverage are changing.

Hospitals shouldn’t wait until open enrollment to explain.

The easiest number to understand can drive the wrong decision

Medicare is complicated. Most people understandably gravitate toward the information they can easily compare: premiums, drug coverage, and supplemental benefits like dental.

The simplicity disappears when beneficiaries try to determine where they can access care. A beneficiary may see an attractive Medicare Advantage plan advertised this fall and reasonably assume their longtime physician or preferred hospital participates. The payor’s provider directory says the same thing. But networks change, and Medicare itself advises beneficiaries to verify that the doctors and hospitals they want are included in a plan.

That assumption is riskier as provider participation in Medicare Advantage dwindles. A plan that looks like a good financial choice in October can become a very different healthcare experience when someone needs an oncologist, cardiologist, orthopedic surgeon, or hospital in February.

There’s another complication that receives far less attention in Medicare Advantage advertising. Switching back may not be as simple as consumers assume.

Someone can leave Medicare Advantage and return to Original Medicare during applicable enrollment periods. Obtaining a Medicare supplemental, or Medigap, policy is another matter. Federal law provides important guaranteed-issue protections in certain circumstances, including initial Medigap enrollment and some Medicare Advantage trial rights. Outside those protections, however, an insurer will use medical underwriting, subject to state law.

In other words, “I’ll just change back if I don’t like it” will become expensive and may not cover all existing conditions.

Hospitals have information patients need before they choose

Health systems spend enormous resources helping patients navigate their insurance after something goes wrong. Open enrollment is their opportunity to help patients before they choose the insurance that creates the problem.

Hospitals can give beneficiaries, especially those aging in, factual, understandable information that helps them make the best decisions.

Hospitals should already be preparing that information for the October 15 start of open enrollment.

Start with network participation. Make it extraordinarily easy for patients to determine which Medicare Supplement and/or Medicare Advantage plans the organization participates in. If participation is changing, communicate it repeatedly, early, often, and through multiple channels.

Educate patients about the questions they should ask before enrolling. Is my primary care physician in network? What about my specialists? Is my preferred hospital included? Does the plan require referrals? Which services require prior authorization? What happens if I travel or spend part of the year in another state?

Hospitals should also equip their own people. Schedulers, call center representatives, physician practices, financial counselors, and front-desk staff will hear these questions long before most executives do. Give them clear, consistent information and an escalation path when they don’t know the answer.

Finally, communicate early. Medicare Advantage plans and brokers certainly are. The advertising has already begun, and by October beneficiaries will have absorbed months of messages about premiums and benefits. Hospitals need to enter the conversation early enough for their information to become part of the coverage decision.

This is an access issue

Healthcare organizations sometimes hesitate to talk about insurance because it feels outside their role. That distinction is becoming increasingly difficult to defend.

A patient’s insurance determines where they can receive care, which physicians they can see, how quickly treatment gets authorized, and what they may pay out of pocket. Insurance coverage has become one of the fundamental determinants of access to care.

Hospitals can help patients make Medicare decisions with a clearer understanding of the consequences those decisions carry.

Kevin Thilborger is chief revenue strategy officer of Unlock Health.