5 Biggest Mistakes Individuals Should Avoid When Enrolling in Medicare

Turning 65 and becoming eligible for Medicare can sneak up on you quickly, and, if not properly prepared for, enrollment can be confusing.  With enrollment deadlines, potential penalties and numerous coverage options available, understanding the process and products are crucial in making the right decision for your Medicare benefits. Medicare is a complex program, but a smooth transition is possible. Here are the 5 biggest mistakes individuals should avoid when enrolling in Medicare.

1. Not enrolling on time.

Many individuals do not know when their Initial Enrollment period begins and/or ends, and ultimately don’t enroll at the appropriate time.

Your IEP is 7 months long and includes your 65th birthday month, plus the 3 months before and the 3 months after.  If you choose to enroll at the incorrect time, you risk incurring late enrollment penalties that could last a lifetime. To avoid penalties, you need to determine if you must enroll during your IEP, or if you are able to delay your enrollment based on your specific situation.

If you are unsure about your initial enrollment period or if you need assistance enrolling in Medicare, you can contact Medicare Portal, visit www.medicare.gov, or contact Social Security via phone or in person. Please note you will not be automatically enrolled in Medicare unless you are receiving Social Security/Railroad benefits prior to age 65.

2. Not knowing the difference between Original Medicare and Medicare Advantage. 

If you are enrolling in Medicare for your primary healthcare coverage, you must decide if you want to keep your Original Medicare (Parts A and B), and perhaps purchase a Part D prescription drug plan and a Medigap/Medicare supplemental policy as well to help cover your financial exposure to out-of-pocket costs.

However, if you determine that Original Medicare does not provide you enough coverage, you can enroll in a Medicare Advantage plan (Plan C) that would replace your Original Medicare benefits. Medicare Advantage plans are Medicare plans operated by private insurance companies which offer benefits that meet or exceed those found in Original Medicare. Medicare Advantage plans have a network of providers, including doctors, pharmacies, hospitals and other healthcare services, that are approved by the private insurance companies.

Typically, a Medicare Advantage plan will bundle your Part D plan benefits as well as offer benefits for vision, hearing, dental, and gym memberships.

3. Not confirming if your doctor accepts Original Medicare and/or Medicare Advantage.

 This is a very important, but often overlooked, step in your Medicare enrollment. If you have an established relationship with your doctor(s), you might want to ensure that you can continue to see them for medical services. Confirming if your doctor participates in Original Medicare or your local Medicare Advantage plan(s) is best accomplished by contacting your providers by phone or visiting your provider’s office in person. If you make the mistake of enrolling in a plan that your provider doesn’t participate in, you will have to pay out-of-pocket for that provider’s services.

4. Not enrolling in a Part D plan when first eligible.

 Many seniors who are in good health and do not take many medications don’t think they will need prescription drug coverage, and want to avoid any additional out-of-pocket expenses such as a Part D premium. However, what seemed to be a fiscally responsible decision could ultimately cost you for the remainder of your life. Many don’t realize that if you postpone joining a prescription drug plan during your initial enrollment period, but decide later to enroll, you will pay a penalty of 1% per month for every month you went without a Part D plan. This penalty, which is calculated off the National Premium Benefit Average, is around $34.00 per month in 2019.

5. Not reviewing your benefits and options annually.

 Medicare is complex and has a lot of variables. The specific benefits and costs offered with each plan, formularies for prescription drugs, and approved providers in a plan’s network are examples of the many variables that can change each year, and it is up to the beneficiary to keep up with these changes.  Therefore, making sure you are managing your benefits on an annual basis is critical. The Annual Election Period, which is from October 15-December 7 of every year, was created to allow Medicare beneficiaries make changes in their current benefits to ensure that their plan continues to meet their medical and financial needs.

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