Affordable Care Act navigator Nini Hadwen (R) works with Marta Aguirre as she shops for health insurance during a navigation session put on by the Epilepsy Foundation Florida to help people sign up for health insurance under the Affordable Care Act on October 8, 2013 in Miami, Florida. - 

Open enrollment in Medicare begins tomorrow -- that's when any Medicare recipient can change their health or drug coverage plans with no penalties. But add the newly-unveiled health insurance exchanges to the mix and suddenly seniors are confused about where to sign up for what and when.

Express Scripts, a pharmacy benefits management company, polled seniors about Medicare enrollment. It found twenty percent think they can sign up for insurance through one of those new healthcare exchanges. But they can’t.  

“To be fair,” says Amanda Starc, a professor of healthcare management at Wharton, "Medicare options were confusing to begin with and this only adds to the confusion.”

Starc says we know when seniors enroll in Medicare they can be overwhelmed by all the choices like Medigap and Medicare advantage. The more choices they have, the longer they spend trying to make decisions and the more they can end up paying, as a result. Many of the new health care exchanges add to the problem. Because seniors may think they have even more options to choose from.

“So to the extent that consumers end up in plans that cost more, because they’re confused, the federal government is actually on the hook for some of that bill,” she says.

Which really means the taxpayers. So just to be clear. Medicare is for seniors 65 and older, the new exchanges are for everyone else. But the National Council on Aging says seniors beware: Medicare plans for 2014 are not yet up to date -- thanks to the government shutdown.