Here are the Top Ten Medicare mistakes in Illinois, and how to avoid them.
1. Enroll When Eligible
With more people working beyond the age of 65, it’s not uncommon to delay signing up for Medicare, and that’s okay. As long as you have health coverage after age 65 through an employer or a spouse, you can delay enrolling without paying a penalty. However, if you do not have group coverage, the right time to sign up is during your Initial Enrollment Period. This is the seven-month period of time that begins three months before your 65th birthday and ends three months after. There are also Special Enrollment Periods for those with unique circumstances. If you fail to sign up for Medicare when you are first eligible and delay Part B enrollment without proof of other health coverage, you could end up having a lifetime late enrollment penalty added to your premium.
2. Annual Enrollment
Medicare Annual Enrollment takes place each year between October 15 and December 7. This is the time for everyone to evaluate their current Medicare plan to see if changing plans makes sense. Cost and coverage can vary from year to year, and taking the time during Annual Enrollment to review your plan is smart. During Annual Enrollment, you can switch from your Original Medicare to a Medicare Part C plan, change from one plan to another, or return to Medicare. You can also join a prescription drug plan, change plans, or drop one that no longer meets your needs. Not taking advantage of this period means you could end up paying more for your plan or keeping a plan that doesn’t fit your changing needs.
3. Prescription Coverage
One of the biggest mistakes people make concerning Medicare is prescription benefits. If you are healthy and do not take medication, great! However, if you wait to sign up for Part D benefits until you need them, you risk paying a late penalty. if you cannot provide proof of creditable coverage for the time you went without.
4. Plan Based on Cost
Cost is a primary consideration when choosing the right plan. However, with prescription coverage, it is often as important to ensure the prescriptions you require are on the formulary. If you choose a plan based on cost alone and your medication is not listed, you may end up paying much more for what you need.
5. COBRA
After you turn 65, Medicare becomes your primary coverage, unless you have coverage through an employer. However, the coverage must be current, and COBRA benefits or retiree benefits are not coming from a job you still work, and are not considered primary coverage. COBRA benefits extend an employer’s health care benefits for eighteen months. However, you only have eight months, not eighteen months after your group coverage ends to sign up. If you do not sign up for Medicare during this time, you will have gaps in your coverage and may be responsible for paying a late enrollment penalty.
6. Same Plan as Spouse
It’s important to realize that you and your spouse likely have very different healthcare needs. When choosing a Medicare plan, whether it’s for prescription benefits or basic coverage, be sure to think about your unique needs and how the plan you’re considering can help you.
7. Waiting Too Long
You have a full six months after enrolling in Part B to join a Medicare Supplement plan with full protections in place. All recipients who enroll in a plan during this period are entitled to guaranteed issue rights. This means that no company can refuse to sell or charge you more because you have a pre-existing condition. Once this six-month period of time ends, these protections are no longer in place and you may not be able to get coverage.
8. Annual Notice of Change
The Annual Notice of Change that comes by mail each year is filled with critical information on any changes you will see in your Medicare coverage for the upcoming year. Changes in cost, network providers, and even formularies must be noted in this documentation. Read it fully to avoid being surprised by higher out-of-pocket expenses or limited access to health care providers.
9. Extra Help
Medicare has safeguards in place to help those with limited income afford prescription drug coverage. Unfortunately, many Medicare recipients are not aware that they qualify, and could save money on the same plans they pay for each month. Be sure to read about Extra Help and make notes on whether or not you are qualified.
10. Out-of-Network
Medicare Part C makes it easy for seniors to receive all of their Part A and Part B benefits as well as a few extras like prescription benefits and in some cases, vision and dental care. However, most plans have very strict requirements regarding network providers. Going to a doctor or hospital outside the plan’s network could end up costing you a lot more out-of-pocket.
References:
Delaying Part B: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156
Special enrollment periods: https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html
Open Enrollment: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
Part D Late Enrollment: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
Medicare and other insurance: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html
When to buy Medigap: https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html
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