6 Common Medicare Enrollment Mistakes You Should Avoid

1. Missing Enrollment Deadlines

• What happens: If you miss your initial enrollment period and do not qualify for a Special Enrollment Period (such as continuing to work and being covered by an employer group plan with 20+ employees), you will pay a permanent 10% late enrollment penalty for every 12-month period you delayed. 

• How to avoid it:

  Your Initial Enrollment Period (IEP) lasts for 7 months: starting 3 months before your

65th birthday month, includes your birthday month, and ends 3 months afterward.

 

 2: Not understanding the difference between a Medicare Supplement (Medigap) and a Medicare Advantage (Part C) policy Those new to Medicare have a fundamental choice to make: enroll in original Medicare or opt into a Medicare Advantage plan. It is very important to understand the pros and cons of both types of coverage.

Original Medicare (also known as Parts A and B) is a fee-for-service program. Many people supplement this government benefit with a private Medicare Supplement (Medigap) policy and a Part D plan for their prescription drugs.

A Medicare Supplement policy may cover some services that are not included under the standard Medicare Parts A and B. It may also cover some out-of-pocket costs such as:

1. Co-insurance costs for care at skilled nursing facilities

2. The Part A deductible

3. Foreign travel emergency care

 

Medicare Supplement policies have additional monthly premiums. Prior authorization to use specialists or get second opinions is not required.

 

A Medicare Advantage plan (Part C), takes the place of original Medicare Parts A and B. These plans work more like group insurance. They are sold through approved, licensed insurance companies and may have an additional monthly premium. Medicare Advantage plans include prescription drug coverage as well as services original Medicare does not cover like dental and vision care. A Medicare Advantage plan may also limit your ability to use doctors and hospitals and require prior authorization to use specialty services.

If your needs change, switching to a new plan is allowed during the Medicare Open Enrollment Period.

 

3. Focusing Only on the Monthly Premium

• What happens: Choosing a plan just because it has a zero

  or low premium often means you'll pay much higher out-of-pocket costs, copays, or deductibles when you need medical care. 

• How to avoid it: Use the Medicare Plan Finder tool to weigh the total annual cost, factoring in your anticipated prescription usage and maximum out-of-pocket limits. 

 

4. Assuming Your Doctors and Prescriptions Are Covered

• What happens: Enrolling in a plan blindly and realizing too late that your primary care physician, preferred hospital system, or daily medications are not in-network or covered by the formulary. 

 

• How to avoid it: Always verify that your specific doctors and specialists accept the exact plan you are considering by verifying on the insurance carriers directory or calling the provider’s office directly.

 

5. Not Re-evaluating Coverage Annually 

• What happens: Sticking with a plan year after year just because you used to like it. Medicare Advantage and Part D plans frequently change their formularies, networks, and copay structures annually. 

 

• How to avoid it: Review your plan's Annual Notice of Change (ANOC) every September. During the Medicare Open Enrollment Period (October 15 – December 7), compare your plan against others in your area to find the most cost-effective option. 

 

7: Not applying for financial assistance

Millions of older adults are eligible for billions of dollars in programs that can help them pay for their prescriptions and health insurance premiums, deductibles, and coinsurance. If your income in retirement is modest, find out if you qualify for assistance.

These programs include the Medicare Savings Programs (MSPs), NY EPIC and Part D Extra Help.  

 

Need Personalized Help?

If navigating enrollment seems overwhelming, you do not have to guess. You can receive free, unbiased counseling by contacting

 Senior Insurance Solutions at (716) 236-8896 or

• Chautauqua County Office for Aging (716) 753-4582

• NY State of Health (855) 355-5777

• NY Connects (800)342-9871