There’s no question, that navigating the world of Medicare can be complicated, time-consuming, and frustrating. With many different options, varied plans, enrollment rules, and more, it’s easy to make mistakes. Errors can be costly, which is why it’s so important to understand common pitfalls. Here are the top ten Medicare mistakes, and how to avoid them.
1. Failing to Sign Up When You Are First Eligible
With more people working beyond the age of 65, it’s not uncommon to delay signing up for Medicare—and that’s okay. As long as you have health coverage after age 65 through an employer or a spouse, you can delay enrolling in Medicare without paying a penalty. However, if you do not have group coverage, the right time to sign up is during your Initial Enrollment Period. This is the seven-month period of time that begins three months before your 65th birthday and ends three months after. There are also Special Enrollment Periods for those with unique circumstances, such as losing their job. The important thing to remember is that if you fail to sign up for Medicare when you are first eligible and delay Part B enrollment without proof of other health coverage, you could end up having a lifetime late enrollment penalty added to your premium.
2. Not Taking Advantage of Annual Enrollment
Medicare Annual Enrollment takes place each year between October 15 and December 7. This is the time for everyone to evaluate their current Medicare plan to see if changing plans makes sense. Cost and coverage can vary from year to year, and taking the time during Annual Enrollment to review your plan is smart.
During Annual Enrollment, you can switch from your Original Medicare to a Medicare Advantage Plan, switch from one Medicare Advantage Plan to another, or return to your Original Medicare. You can also join a prescription drug plan, change plans, or drop one that no longer meets your needs. Not taking advantage of this opportunity means you could end up paying more for your plan or keeping a plan that doesn’t fit your changing needs.
3. Thinking You Don’t Need Prescription Drug Coverage Because You Don’t Take Medicine
One of the biggest mistakes people make concerning Medicare is failing to think ahead. If you are healthy and do not take prescription medication, great! However, if you wait to sign up for Part D benefits until you urgently need them, you risk paying a late penalty if you cannot provide proof of creditable coverage for the time you went without.
4. Choosing a Prescription Drug Plan Based on Cost Alone
Cost is a primary consideration when choosing the right Medicare plan. However, with drug coverage, it is often as important to ensure the drugs you use are on the formulary. If you choose a plan based on cost alone and your medication is not listed, you may end up paying much more for what you need.
5. Thinking You Have More Time to Enroll in Part B With COBRA Benefits
After you turn 65, Medicare becomes your primary coverage, unless you have coverage through an employer. However, the coverage must be current, and COBRA benefits or retiree benefits are not coming from a job you still work, and are not considered primary coverage.
COBRA benefits extend an employer’s health care benefits for eighteen months. However, you only have eight months, not eighteen months after your group coverage ends to sign up. If you do not sign up for Medicare during this time, you will have gaps in your coverage and may be responsible for paying a late enrollment penalty.
6. Choosing the Same Plan as Your Spouse
It’s important to realize that you and your spouse likely have very different healthcare needs. When choosing a Medicare plan, whether it’s for prescription drug benefits or Original Medicare, be sure to think about your unique needs and how the plan you’re considering can help you with your medical needs.
7. Waiting Too Long to Enroll in Medicare Supplement Insurance
The good news is, that you have a full six months after enrolling in Part B to join a Medigap plan with full protections in place. All recipients who join Medigap during this period are entitled to “guaranteed issue rights”. This means that no company can refuse to sell you a plan or charge you more for a plan because you have a pre-existing condition. Once these six months end, these protections are no longer in place and you may not be able to get a Medigap plan.
8. Forgetting to Review Your Annual Notice of Change
The Annual Notice of Change that comes by mail each year is filled with critical information on any changes you will see in your Medicare coverage for the upcoming year. Changes in cost, network providers, and even formularies (list of covered drugs) must be noted in this documentation. Read it fully to avoid being surprised by higher out-of-pocket expenses or limited access to health care providers.
9. Not Taking Advantage of Extra Help
Medicare has safeguards in place to help those with limited income afford prescription drug coverage. Unfortunately, many Medicare recipients are not aware that they qualify, and could save money on the same plans they pay for each month. Be sure to read about extra help and make notes on whether or not you are entitled.
10. Going Out-of-Network with a Medicare Advantage Plan
Medicare Advantage makes it easy for seniors to receive all of their Part A and Part B benefits as well as a few extras like prescription drug benefits and in some cases, vision and dental care. However, most plans have very strict requirements regarding network providers. Going to a doctor or hospital outside the plan’s network of providers could end up costing you a lot more out-of-pocket.
References:
Delaying Part B
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156
Special enrollment periods
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Open Enrollment
https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
Part D Late Enrollment
https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
Medicare and other insurance
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
When to buy Medigap
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
MUC68-2017-SSI:CDIS
