5 Medicare Enrollment Mistakes You Don't Want to Make

I have had the flu this week (thanks to the husband). You know the kind you get when your husband was sick for two days in his chair, but you are in your bed feeling like it's over. I am on the mend now, so Medicare Monday is arriving a little later this week.

I recently answered the question, “What is the biggest mistake seniors make when enrolling in Medicare?” My answer is simple. Teating Medicare like it is one-size-fits-all. Many of the most common Medicare enrollment mistakes happen when people assume the same rules or coverage choices apply to everyone.

Medicare decisions are personal. Your enrollment timeline, work coverage, doctors, prescriptions, budget and travel habits may be completely different from those of your spouse, neighbor or best friend. A choice that works beautifully for someone else could leave you with higher costs, uncovered medications or doctors who are out of network.

That one big mistake often shows up in five different ways.

1. Missing a deadline or assuming enrollment is automatic

Many people believe Medicare automatically begins when they turn 65. That is not always true.

According to Medicare.gov, you are generally enrolled automatically at 65 if you began receiving Social Security benefits at least four months before turning 65. If you are not receiving Social Security yet, you may need to enroll yourself.

Your Initial Enrollment Period usually lasts seven months: the three months before your 65th birthday month, your birthday month and the three months after it. Waiting too long can cause a gap in coverage, and in some situations it may lead to late-enrollment penalties.

The safest approach is to check your enrollment status early. Do not wait for a Medicare card and assume everything is being handled behind the scenes.

Working past age 65 does not automatically mean you should enroll in every part of Medicare or delay all of it. The right timing depends on where your coverage comes from and how it coordinates with Medicare.

Important questions include:

• Is the insurance based on your current employment or your spouse’s current employment?

• How many employees does the employer have?

• Is your prescription coverage considered creditable?

• Are you contributing to a Health Savings Account?

• When will the employer coverage end?

COBRA and retiree coverage do not follow all the same rules as insurance based on current employment. Medicare provides an eight month Special Enrollment Period for Part B in many situations after employment or qualifying job-based coverage ends, but drug coverage has different timing rules.

Before making a decision, ask the employer’s benefits administrator for written information about how the group plan works with Medicare. A simple assumption here can become an expensive mistake.

3. Confusing Medigap with Medicare Advantage

The similar names cause plenty of confusion, but these are two different ways of handling your Medicare coverage. Medicare Advantage, also called Part C, is an alternative way to receive your Medicare benefits through a private insurance plan approved by Medicare. These plans include Part A and Part B and usually include Part D prescription drug coverage. Depending on the plan, you may need to use a provider network and receive prior authorization for certain services.

Medigap, also called Medicare Supplement Insurance, works alongside Original Medicare. It helps pay some of the deductibles, copayments and coinsurance that Original Medicare does not pay. Medigap policies sold today do not include prescription drug coverage, so a separate Part D plan is generally needed.

You cannot use Medigap and Medicare Advantage together. Medicare.gov offers a helpful comparison of Original Medicare and Medicare Advantage, including differences in costs, provider access and prior authorization. Neither path is automatically “better” for everyone. The better choice is the one that fits your healthcare needs, finances and preferences.

4. Choosing a plan based only on the monthly premium

A $0-premium Medicare Advantage plan is not a $0-cost healthcare plan. You must continue paying your Medicare Part B premium, and the plan may have copayments, coinsurance, deductibles and other out-of-pocket costs as you receive care. Likewise, the lowest-priced drug plan may not be the least expensive choice once your prescriptions and preferred pharmacy are included.

Look beyond the premium and ask:

• Are my doctors and hospitals in the network?

• Are my prescriptions on the formulary?

• What will my medications cost at my preferred pharmacy?

• What are the copayments for specialists, hospital stays and outpatient procedures?

• What is the plan’s maximum out-of-pocket limit?

• Will the coverage work when I travel?

Medicare’s Plan Compare tool can help compare estimated drug and plan costs. The monthly premium matters, but it is only one piece of the financial picture.

5. Following social media or a friend’s advice without comparing your own needs

Friends and family usually mean well. Social media groups can also be useful for hearing about someone’s personal experience. The problem begins when personal experience is treated as personalized advice.

Your friend may take different medications, use different doctors, live in another county, travel more or less than you do, or have a completely different budget. Even two people living on the same street may need different plans.

Instead of asking, “Which plan should I choose?” ask your friend, “What do you like and dislike about your coverage?” Their experience may give you good questions to ask, but it should not make the decision for you.

Avoid Medicare enrollment mistakes by choosing coverage that fits your life

The biggest Medicare mistake is not choosing one particular type of coverage. It is making a decision without first understanding how the choice fits your own situation. Start early, verify your enrollment dates, understand how any work coverage coordinates with Medicare and compare the total picture, not just the premium or extra benefits.

Most importantly, make sure your doctors, prescriptions, healthcare needs and budget are part of the review. As a licensed independent health insurance agent, I help people understand their Medicare choices by comparing available plans and explaining the differences in plain language. If you are approaching Medicare or are unsure whether your current coverage still fits your needs, I’m happy to help. Call and ask for Cheryl at ((656)228-4979 or schedule an appointment online https://www.coralbayins.com/book-online.

This article is for general educational purposes and is not a substitute for guidance based on your individual circumstances. Plan availability, benefits, provider networks, formularies and costs vary by plan and location.