Where your finger stops on the letter

Tuesday, 11:40 AM, the pharmacy counter of a drugstore on Amsterdam Avenue.

The line was four deep and moving at the speed of insurance. The woman third in line was about sixty-seven. She wore a camel coat and had a folded tote over one wrist. Her reading glasses were pushed up into her hair, which told me she did not plan to read much.

She pulled out the letter plans mail every September, the one listing next year's changes. It ran to many pages. She gave it the attention most people give a terms-of-service box.

Her index finger went down the first page like a metal detector. It stopped on one number and tapped it twice.

Then she folded the letter shut. She never turned the page.

Her finger had stopped at the premium.

Her finger did the reading. It passed the plan name, stopped on the monthly premium, tapped twice, and quit. The complication is that the stop may have been sensible. CMS's 2027 plan projections, released Monday, Sept. 28, show average Medicare Advantage premiums falling from $14.37 a month this year to $12.00. The agency also says about eight in ten Advantage members can keep their plan at the same premium or less. Standalone drug plans should average about $36, up less than a dollar. For insurers, the backdrop is a 2.48% rise in payments to Advantage plans, set in April. The premium is real news. It is also the line printed largest.

Economists have studied that stop. Jason Abaluck and Jonathan Gruber matched real drug claims to the Part D plans people chose, then checked each choice against the costs it produced. People weighed premiums far more heavily than the out-of-pocket costs they actually faced. The authors estimated people would have been about 27% better off choosing on full costs. The paper gives no simpler absolute figure. The finding is contested. A 2016 reanalysis of 2006–2010 records found about 79% of choices passed basic tests of sensible behaviour. The original authors replied that those tests are too lenient to catch mistakes. What nobody disputes is how few people look. In federal survey data on 2022 coverage, 69% of beneficiaries did not compare plans. Among Advantage members, 43% did not check their own plan's cost changes.

When your plan's letter of changes arrives, put a finger on the premium, then make yourself turn the page. Find three lines: the yearly out-of-pocket limit, whether your doctors stay in the network, and what your regular prescriptions will cost. Write down which one you would have skipped. That is where your eye stops. It is not a verdict on the plan.

File status: open

I don't know her plan, her doctors, or whether she turned the page at home. The CMS numbers are national averages and projections, and her county's will differ. Open enrollment runs October 15 to December 7, and nothing about it is a race. Tomorrow, a subway platform, and what a man's breathing gives away.