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Sacramento Boomer

Health is Wealth: 8 Medicare Mistakes to Avoid

Dec 26, 2019 04:18PM

For those approaching age 65 and preparing to enter the Medicare system, understanding the language and nuances can be confusing. Mistakes can range from monetary penalties to lack of simple services or, worse, absence of essential coverage in times of emergency. In order to help navigate through its complexities, we compiled a list of common mistakes to avoid.


1) Missing the initial enrollment period.
As you approach 65, you’ll want to enroll during what the government calls your initial enrollment period (IEP)—a seven-month period that goes from three months before the month in which you turn 65 until three months after. If you don’t sign up during your IEP, you’ll get another chance to enroll during Medicare’s annual general enrollment period, from January 1 through March 31 of each year. However, if you join at that time, your coverage won’t begin until July. And, because you enrolled late, your monthly premiums for Medicare Part B, which covers your doctor visits and other outpatient services, will likely cost you more. 


2) Confusion about the special enrollment period.
If you’re 65 or older, when you stop working and lose your health insurance coverage or when the insurance you have through your spouse ends, you’ll need to sign up for Medicare. Medicare has created a special enrollment period (SEP) that lets you do that without facing a late enrollment penalty.


3) Not understanding Part B and Part D late enrollment penalties.
For every 12 months you delay enrolling in Part B, your monthly Part B premium may be 10% higher. The penalty won’t apply if you have job-based insurance or are still under your Special Enrollment Period. For every 12 months you delay signing up for a Part D plan, your monthly premium may be 1% higher. Part D plans cover prescription drug costs. You won’t have to pay the Part D penalty if you can show Medicare that you have drug coverage as good as that provided by a Medicare Part D plan. 


4) Not purchasing enough coverage. While Medicare Part A is free, Parts B, C, and D all require a monthly premium. Most people should probably get at least Part B so that they have coverage for doctor’s visits and outpatient care. But Parts C and D can also provide important coverage for things like dental, vision, and prescription drugs. You can also opt for a Medicare Advantage policy that helps to defray these costs. A Medigap insurance policy can help you to pay for things that are not covered elsewhere, like coinsurance, copays and deductibles.


5) Not understanding your out-of-pocket costs.
Although Medicare pays the lion’s share of the medical costs for its enrollees, you need to be prepared for sometimes-substantial out-of-pocket costs. 


6) Not seeking assistance if you can’t afford the premiums.
If your income is low enough that you will have trouble affording the premiums, your state or local department of social services may have programs available for those who financially qualify.


7) Falling prey to scams.
Every fall, when the program’s 60 million or so beneficiaries can make coverage changes for the next year, criminals tend to step up their game, experts say. It could involve a person pretending to be a Medicare representative, a fraudulent provider trying to prescribe you with medical equipment or services, or any other undertaking with the goal of stealing your personal information or your money. 


8) Having a plan through Covered California excuses one from enrolling in Medicare.
Even though the federal  "individual mandate" has been rescinded, having a program through the Covered California exchange does not prevent late enrollment penalties if one delays Medicare enrollment when eligible.  


Want to Learn More

Many health care providers and advocacy groups regularly hold informational seminars and/or consulting on Medicare-related FAQs and processes. Check your provider for others. Here are a few we recommend: