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Medicare Enrollment: Mistakes to Avoid

Article at a glance
  • One of the largest mistakes people can make when enrolling in Medicare is not entirely understanding enrollment periods. To learn more about enrollment periods, read this section.

  • It’s vital to consider cost when enrolling in a Medicare insurance plan. To learn more about premiums and out-of-pocket expenses, read this section.

  • As we age, our health and wellbeing change. To learn more about health changes and how Medicare can help, read this section.

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Over 60 million people who are Medicare-eligible are Medicare beneficiaries. Of that, a little over 24 million are currently on some sort of Advantage Plan, with that number expecting to rise even more in the coming year. With so many people aging into Medicare benefits, it could be a good idea for you to look into the plan you currently have, to make sure it’s still the best option for you.

Mistake #1: Not Completely Understanding Enrollment

Enrollment can be tricky as there are multiple times when one can sign up for a standard Medicare or Medicare Advantage plan. Such enrollment periods include one’s initial enrollment period, general enrollment period, and fall open enrollment. 

Initial Enrollment Period (IEP)

The medicare initial enrollment period is the most standard option for enrolling in original Medicare or MA plans. The timeframe for an IEP is a seven-month stretch: the three months before a patient turns 65, the month of their 65th birthday, and the three months after they turn 65. Most patients are automatically enrolled in Medicare Part A at this time and will receive a welcome packet that guides them through the enrollment process. However, it’s the patient’s responsibility to further sign up for Medicare Part B or an all-inclusive MA plan at this point; if they delay enrollment, there could be impending penalty charges.

Note: To learn more about the Initial Enrollment Period, visit this source.

General Enrollment Period (GEP)

For individuals that missed the IEP, they are welcome to join during the general enrollment period. For standard Medicare coverage, the GEP timeframe is from January 1st to March 31st, and for Medicare Advantage plans, it’s April 1st to June 31st. For both of these timeframes, a patient’s coverage will begin starting July 1st

Note: To learn more about the General Enrollment Period (GEP), visit this source.

Fall Open Enrollment 

Patients who are looking to switch their insurance plan can do so during Fall Open Enrollment. Switching a plan can look like going from standard Medicare to an MA plan, switching the type of MA plan one has (e.g., HMO to a PPO insurance plan), adding on a Medigap plan, and more. This timeframe is from October 15th to December 7th, with coverage beginning on January 1st.

Note: To learn more about Fall Open Enrollment, visit this source.

Special Enrollment Period

A special enrollment period is for those that undergo a life change that causes them to lose their coverage, allowing them to enroll later on. The special circumstances required for eligibility are vast and to learn more about what they entail, visit this source.

Mistake #2: Not Considering Out-Of-Pocket Expenses

Whichever plan or policy you decide upon, make sure to look beyond the premiums and consider your out-of-pocket expenses. While it’s true that insurers are federally regulated, the specifics of their options vary from plan to plan, year to year, or even county to county. These yearly changes could have an impact on your premiums, deductibles, and other costs like co-pays, and services such as dental and vision.

When eHealth asked 1,000 Medicare beneficiaries what their top healthcare concerns were, 42% said it was the cost of Medicare premiums, while a little over 50% cited co-pays and deductibles as their top concern. What this means is that regardless of the plan you choose, it’s important to not lose sight of monthly premiums and other expenses relating to your overall healthcare.

It’s also important to note that while cost will always be a factor, not enrolling in Medicare when you become eligible will cost you more in the end when it comes to Medicare Part B. When one is eligible to enroll in Original Medicare or is automatically enrolled, they should also take the time to enroll in Part B. If they choose to enroll in Part B late, they will be charged a fee that remains consistent on their monthly premium moving forward.

Elizabeth Gavino,, Founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans

Medicare Costs to Consider

When enrolling in Medicare, one should consider all out-of-pocket costs including their monthly premiums, overall deductibles, copayments, and coinsurance. Original Medicare plans typically only include a monthly premium for Part B, but when it comes to Medicare Advantage plans, there are more costs to consider.

Premiums

For Original Medicare and MA plans, individuals must pay the Part B premium. In 2022, the average premium cost is $170.10 and up, depending on one’s income. Paying a premium for Part B is standard when it comes to any kind of Medicare plan and it is normally deducted from one’s monthly Social Security payment.

Deductibles

A deductible cost is only relelvant when discussing Medicare Advantage plans. One’s deductible is the amount they must pay for health care or prescription drugs before their insurance begins to step in and cover costs. Deductible costs vary depending on the patient’s MA plan type since they are provided by private insurance companies (i.e., HMO, PPO, etc.).

Copayments

A copayment is the share a patient must pay for any health care service such as a doctor’s visit, prescription drug allocation, or outpatient care. Copayment costs vary depending on the MA plan type a patient chooses (i.e., HMO, PPO, etc.).

Coinsurance

Coinsurance refers to the percentage a patient must pay for certain services once their deductible is paid off. The rate of coinsurance cost varies depending on the MA plan type a patient selects (i.e., HMO, PPO, etc.).

Mistake #3: Not Staying Up-to-Date on Medicare Changes

When we think of costs and insurance, we automatically consider it as a monetary question. It’s true, you shouldn’t overextend yourself and select a plan that makes it difficult to meet your other financial obligations. However, the cost we’re considering in these terms has more to do with the cost of choosing the wrong plan, not selecting one at all, or even sticking with the plan you currently have only to find out on January 1st there were expensive changes made to your plan. These are the costs that take a toll on a lot of people. 

The number of Seniors who have declared bankruptcy due to a sudden change in their health and lack of proper coverage has doubled since 1999. Also, according to Registered Nursing, by the time you reach 65 years old, average healthcare costs are $11.3K per person, per year in the United States. And over the span of a lifetime, the average cost of healthcare for an individual would have cost around $400,000.

As you age, it’s easy to assume your kids or other loved ones will be there to care for you and your needs. But in reality, as you age the cost of your care goes up, and there might not be enough your family can do if you’re not properly covered. What’s even more remarkable, is that healthcare costs are, on average, more for women than men. All this to say, it’s important to stay up to date on yearly Medicare changes so you can track upcoming changes and how it will impact your benefits and annual costs.

Note: To learn more about the Medicare changes in 2022, visit this source.

Mistake #4: Expecting Your Health to Remain the Same

As you get older your body reacts differently to various conditions. Of course, we can see age in the way we look on the outside, from our hair turning colors, or our skin forming a few more age lines around the eyes. But, in truth, it’s what’s happening inside us as we age that is a greater concern when it comes to your health. Sure, age spots can be signs of serious issues, and there are many other tell-tale signs and conditions to be on the lookout for, but it’s what’s happening inside us, as we age where we need the most protection. That’s why being prepared for the unexpected is such a concern when you turn a certain age.

Aging can affect you in more ways than you imagine. The most common way your health changes is through the cardiovascular system. Your blood vessels and arteries could stiffen, causing your heart to work harder to pump blood through them, something you may not have experienced at a younger age. So just in aging, your blood pressure has to work better than it did when you were younger. 

Another way you may see yourself getting older is through your joints and bones. As you age, bones tend to shrink in size and density, weakening them and making them more susceptible to fracture. You might even become a bit shorter. Muscles generally lose strength, endurance, and flexibility — factors that can affect your coordination, stability, and balance.

Even your digestive system and bladder age. This causes even more problems you might not have experienced when younger. 

All of the above issues come with aging, but there are many more. That’s why even if you have somehow lived your life on the good side of health until now, you’re really only playing with time until something happens. That’s why it’s so important to enroll in Medicare when you become eligible. And to even consider an Advantage plan that can help you with things like gym memberships to help strengthen your heart muscle and your bones. 65 is a unique time of life for many older adults. It allows you to tap into the wealth of government health programs, namely Medicare, to help you achieve the healthcare goals you might have put off otherwise.

Mistake #5: Not Maximizing Your Plan’s Value

When it comes to paying for your health, especially if you’re a senior on a fixed income, making sure you are getting the most from your plan benefits makes real sense. That’s why it’s a good idea to look at the many options each plan offers. Original Medicare encompasses Part A (hospital insurance) and Part B (Medical Insurance). Meanwhile, Medicare supplement insurance such as Medicare Advantage plans, Medigap (MedSupp) plans, or Medicaid-Medicare Dual Eligibles Plan help patients to cover additional costs such as prescription drug coverage, vision insurance, and more.

Potential Offered Services

Gym Memberships

Many Medicare Advantage plans include discounts to gyms in one’s county or codes for online exercise classes. Some MA plans even offer access to Silver Sneakers plans that include meal planning, online classes, in-person workshops, and more.

Note: To learn more about Silver Sneakers programs, visit this source.

Dental

Most MA plans include access to dental insurance benefits. Since MA plans are provided by private insurance companies, the services included in dental coverage may vary.

Note: To learn more about Medicare and dental, visit this source.

Vision

Most MA plans include access to vision insurance benefits. Since MA plans are provided by private insurance companies, the services included in vision coverage may vary.

Prescription Drug Coverage

Most MA plans include access to prescription drug coverage benefits. Since MA plans are provided by private insurance companies, the services included in drug coverage may vary.

Note: To learn more about Medicare Advantage Prescription Drug Plans (MAPD plans), visit this source.

Transportation to Appointments

Many Medicare Advantage plans include additional benefits to things such as appointment transportation for individuals without cars or those that require extra assistance. 

Many providers are also willing to provide transportation services to their patients, such as Oak Street Health via their green van service. Be sure to contact one’s insurance provider as well as their primary care physician to see what services are covered when it comes to transport.

Note: To learn more about Medicare and transportation services, visit this source.

Other Services

All insurance plans often include access to additional benefits like discounts on eyewear, meal plans, supplements, and more. It’s important to contact your insurance provider to ensure you understand all the benefits offered to you and how you can use them. 

Note: Oak Street Health has providers that are trained and ready to guide patients through their insurance benefits.

What’s most important when it comes to selecting a health plan right for you, is to consider how you feel now might not be how you feel down the road. And the care you currently have might need to change due to circumstances beyond your control. So choosing a Medicare plan that provides the benefits you need to meet your healthcare goals could be the only real thing you have any control over.

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