Showcase Listing

Birchwood at Brambleton is an exciting new community for active adults 55+ located in the heart of Loudoun County, and is intentionally d...

Image
Showcase Listing

Wendell Falls is a new, all-ages community located just minutes from downtown Raleigh, North Carolina, and features an eclectic, walkable...

Image
Showcase Listing

Cresswind Charleston is Charleston-area's BEST active adult lifestyle community. Cresswind inspires active adults to live life to the ful...

Image
Showcase Listing

Few towns in the Southeast offer more gracious charm than Aiken, South Carolina.  Take a relaxing stroll through Aiken's tree-lined ...

Image
Showcase Listing

Brookfield Residential at Two Rivers is a brand new community designed for those 55+, and offers an abundance of opportunities for a vibr...

Image

Five Medicare Mistakes You Don’t Want to Make

Category: Medicare

July 13, 2022 — Medicare is a very popular and powerful benefit. Many people look forward to being eligible for it, especially those who are no longer covered by their company but are not yet 65 years of age. It is such an important benefit that you do not want to make any mistakes in signing up for it. We hope this article will be useful, both for people who have not yet signed up for Medicare, as well as those who are already in the program. It is part of our series on Medicare and health care insurance. See the bottom of this page for links to more articles on the topic, which includes a link to our Interactive Quiz: What Is Your Medicare IQ.

Here is the basic background about Medicare:

What is Medicare, and who is eligible?
Medicare is health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig’s disease. Medicare has four parts — Part A, which is hospital insurance, Part B, which is medical insurance, Part C, which is Medicare Advantage Plans, and Part D, which is Prescription Drug Coverage. You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. Medicare is different from Medicaid, which is a joint Federal and State program that helps pay medical costs for some people, irrespective of age, with limited incomes and resources.

Biggest Medicare Mistakes

1. Not signing up for Medicare at age 65 if you are not already enrolled in Social Security or still actively working.
If you are receiving Social Security benefits you will automatically be enrolled in Medicare Part A (it’s free for most people). But if you decide not to apply for SS by age 65, you have 7 months to enroll in Medicare (3 months prior to your 65th birthday, your birthday month, and 3 months later). The only valid excuse for not signing up at age 65 is when you are actively working and have coverage in a group plan. If your spouse is covered in the group plan, he or she can also delay signing up for Part B.

The penalties for not signing up on time for Part B are severe. For one, there is a 10% lifetime penalty for every 12 months you delay Part B enrollment (e.g.; a 3 year delay equals 30% penalty). Another major penalty is that if you don’t sign up and then need major medical care, you might not be able to get coverage for a long time. First you must wait for the Jan-March sign-up period, and even after that the coverage will not start until the following July. In the case of a catastrophic illness, the consequences of not having coverage could be very serious.

2. Choosing a plan that doesn’t work for you.
It is important to understand the various Medicare plans (Parts A, B, C, and D), and then choose the right one among them. Part A (hospitalization coverage) enrollment is automatic when you sign up for Social Security and is free for most people. But making the choice between Part B (medical care from doctors, etc.) or C (Medical Advantage) is more complex. Part B generally gives you more hospitals and doctors to choose from, but at a higher cost. Part C offers lower costs and deductibles, and can offer additional coverages like vision and dental, but with more limited choices. For a retired snowbird the choice might be easy – the Part C network choices are probably not available in both your winter and summer locations, so you have to go with Part B. For others it is a decision that will require some thought.

Medigap policies are private insurance options you can get on top of Part B or C. These help you reduce your out of pocket costs, but you need to pick the right one for your needs. For example, some plans might make you pay extra for certain pre-existing conditions, while others do not. It is important to compare different plans against your situation.

3. Missing the deadline sign-up for Medicare after leaving your job.
You do not have to sign up for Medicare if you are actively working at age 65 and getting health care insurance. But when you leave that job, you have 8 months to do so. Severe penalties will apply if you do not.

4. Not signing up for Part D (Prescription Drug Coverage) on time.

Your editor messed this one up – he signed up for Part D late (at age 67 instead of 65), and as a result will pay an extra monthly premium for the rest of his life. Sign up when you are 65 and be smart (if you have coverage through your employer you can delay).

5. Failure to review your plan choices every year during the open enrollment periods.
Every year you need to review your situation against your coverage. The time to do that is during the open enrollment period, which usually starts on October 15 and runs through December 7. For example, is Part C still a good choice for your situation, or is Part B better? Maybe you have moved and the doctor network that covers you is not as robust, or your doctor is no longer in the plan. Perhaps the cost factor between B and C plans has narrowed. Maybe you can get a lot better deal on your Medigap insurance, or you need to step up coverage because of your changed medical situation. Failure to review your situation could mean that you don’t have the access or the coverage that you need. See our article on “Open Enrollment“.


Part D plans (prescription drug coverage), also offered by private insurance companies, can be be very volatile and need to be watched. Prices and availabilities are largely driven by what drugs you take, or what you might need in the future. The experts caution against putting your Part D plan on autopilot, because if you do you might find yourself paying a lot for drugs you don’t take any longer, or not covered for some you do need.

Bottom line
Medicare is a great plan and a comfort to millions of Americans over 65. But if you don’t get enrolled on time, or take it for granted down the road, you could jeopardize that piece of mind. Back a few years ago we published a similar article about Medicare mistakes. It generated 93 very interesting and thoughtful Comments – definitely worth checking out!

For further reading

What Is Your Medicare IQ – Interactive Quiz
Medicare and You Handbook 2022
So You’re Turning 65: Your Medicare 101 Guide
Topretirements Survey Report: Medicare Is a Great Program, Please Keep it That Way!“, reports on the results of our Member survey on Medicare.
What to Do About Health Insurance If You Retire Before Age 65“.

Posted by Admin on July 11th, 2022

22 Comments »

  1. We were on a Medigap plan for several years and the cost for part B and D got more expensive each year. Now we switched to Medicare Advantage (C) as all our doctors are on the plan through Humana. Now we pay $15/month and have small copays .

    by Bill — July 12, 2022

  2. Avoid Medicare advantage plans unless you never get I’ll! The slick marketing dangles extras you may not receive unless you are also a Medicaid recipient! Your coverage for hospital stays and surgical actions are reduced! Your choice of doctors limited!
    Research before you leap

    by Ron — July 12, 2022

  3. Ron, It sounds like you have had a bad experience with your choice. We, on the other hand, are very happy with our Medicare Advantage plan (Kaiser Senior Advantage). Our premiums are among the lowest available in our area, our out-of-pocket payments are very slim for treatments and prescriptions, and their communication system is top notch. We are so grateful to live in a state that has Kaiser coverage.
    It’s like you said, “Research before you leap!”

    by Green Tbird — July 12, 2022

  4. Our Medicare Advantage Plan (Aetna Medicare Advantage PPO) is not inexpensive but, with two of us immunocompromised and with chronic conditions, it pays for itself. Our plan is through my former employer, a large school system.

    by Alsochristie — July 13, 2022

  5. Editor said..”Your editor messed this one up – he signed up for Part D late (at age 67 instead of 65), and as a result will pay an extra monthly premium for the rest of his life.””

    But that extra monthly premium is very small. IIRC, it’s only about $10 a month if you wait two years.

    “Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.37 in 2022) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.”

    by Dave — July 13, 2022

  6. Ron, Our experience is much like that of Green Tbird–with UHC rather than Kaiser.

    by JoeG — July 13, 2022

  7. Confused. I had a long conversation with someone at SS who said I am not required to sign up for Medicare as I do not live in the US and will not be able to use it. Your article states I will automatically be enrolled in part A upon taking SS. I do not want part A as I will then not be able to contribute to my health savings account. Receiving mixed messages and need facts.

    by DBC — July 13, 2022

  8. I wanted to comment on the editor’s thought about snowbirds that “the Part C (Medicare Advantage) network choices are probably not available in both your winter and summer locations, so you have to go with Part B.” That shouldn’t necessarily dissuade you from fully checking out MA policies. We are snowbirds and legal residents of Florida, but still spend about 5 months each year in Connecticut, where I worked before retiring. MA plans that are PPO’s usually have lots of out of out-of-state provider choices in their networks. All of our doctors, hospitals and other medical providers in Connecticut are covered by our Medicare Advantage PPO plan, plus all of my continuing prescriptions (5 different generics) are covered at no cost through their mail order pharmacy, OptumRx. Our monthly MA premium is $0 and has been since I became eligible for Medicare 8 years ago. Most MA plans are HMO’s which are more limited in network coverage, especially geographical, so it pays to check out MA PPO’s. Also note that all Medicare Advantage plans, both HMO and PPO, must by law cover emergency (and sometimes urgent care) services and follow-up wherever you may happen to be in the U.S.

    Editor’s comment: Great points Clyde. PPOs are a good example that all Medicare Advantage plans are not the same. They are certainly worth investigating to see if they work for your situation. We should have included that in our discussion, very glad you brought it up.

    by Clyde — July 14, 2022

  9. Does anyone have United Healthcare advantage plan? I have heard some horror stories about it

    by Beebs — July 15, 2022

  10. We’ve had it for several years and are very pleased.
    Our docs are in the network.
    No additional cost per month.
    Includes dental, vision, and $40 / quarter of OTC supplies.

    by Tom Quickel — July 16, 2022

  11. Hi Tom
    Do you have the PPO plan and if your out of the country can you use it for emergencies?
    Thanks!

    by Beebs — July 17, 2022

  12. We are confused. We have Medicare Part A. We were going to sign up for Part C (a Priority Health plan) and were told we couldn’t (by the individual presenting the plans), unless we signed up for Part B first. We have since signed up for Part B, to begin in November when we go off group insurance from our jobs. We thought there was a choice- Part B or Part C, and information seems conflicting, no matter what we read. We are both healthy, I am on one medication for cholesterol, and my spouse is on two (cholesterol, COPD), if that helps with information.

    by PS — July 17, 2022

  13. My mother was in her 90s when I discovered to my horror that she was not in a Part D (Prescription Drug) plan. Fortunately she was not on any regular prescriptions, but at that age you never know what kind of expensive drug she might need in the future. So I had her sign up, only to find out that her penalty was very high (should have signed up at age 65, so she had racked up 1% a month penalty on the base premium times 25 years: 25 x 12 = 300% plus compounding) that it wasn’t worth it, so we cancelled. She was just lucky she never needed anything.

    by Rick — July 18, 2022

  14. Rick, this sounds like your particular situation with your mother has passed, but one possibility might have been to switch her to a Medicare Advantage plan, if available, which includes drug coverage, common with many MA plans. I don’t think there’s any penalty if one switches from original Medicare to MA and gets the built-in drug
    coverage. I’m glad it worked out that your mother didn’t need any major drug coverage.

    by Clyde — July 18, 2022

  15. After just reading about Rick’s mother never signed for part D of medicare & the penality cost involved the thought crossed my mind that we might all want to check on loved ones & ask those all personal questions about if & what they have for coverage. I’m sure some will not want to discuss & may even be mad about asking about personal finances. But better to ask because we love/care than to find out too late. Rick was indeed lucky his mum never needed to learn the hard way.

    by VTRetiree — July 19, 2022

  16. There is one other mistake I would suggest – that of signing up, and paying, for things you don’t need or cannot use. We investigated the dental portion of Medicare coverage but when the Anthem Rep did a search, there were NO dentists with in 50 miles that will take Medicare. None. Thus, we pay a yearly payment, through DH’s former employer in TN, for their Delta Dental group. They have treated us well.

    Some eye care, so far, has been classified as “medical” so Medicare has picked up a lot of that expense. Our Medicare Advantage program through Anthem has cost us nothing, so far, and covered a LOT.

    by HEF — July 19, 2022

  17. Beebs, we also have UnitedHealth and no issues. Whether the cover out of country depends on the plan you choose.

    by RichPB — July 20, 2022

  18. I only have a few more days to choose a drug plan. I’m looking at the Humana plan, but it seems to be one of the more costly plans. I’m told the available plans cost between $7-25.00 per month. How in the world can you choose a plan when you are 65, when you have no idea what drugs you may need in the future? I’m in TN and loving it

    by Caps — July 20, 2022

  19. Caps,
    Unfortunately you have to select your drug plan based on what you know today. If and when your circumstances change you can change your plan during Medicare Open Enrollment for the following year, Oct 15-Dec 7 every year. That said, you could change your plan and then have a change in circumstances again the following year. You are locked in for the year unless you are eligible for a program called Extra Help administered by Social Security (income levels are low for this program). If you really need a specific drug and it is not on your plan’s formulary your doctor can often help you get an exception.

    It is important for everyone to check their drug coverage (stand alone drug plan and Advantage plans) every year during open enrollment as plan formularies change every year.

    by Roberta — July 21, 2022

  20. Thanks Roberta,
    From what can find, it seems like the deducables are so high, it doesn’t look like it will even help all that much. Does anyone have a drug plan that works for them and they like? Am I missing something? Would it work just to get an inexpensive plan, just to avoid the penalties, since the deductables seem so high anyway?

    by Caps — July 22, 2022

  21. Caps-

    Hopefully this will be helpful to you as I have been in the same situation you find yourself in. I take very little in the way of medication and with the high deductibles it was obvious I would never meet that deductible. So I went onto Medicare’s website to review my options and found a Part D prescription drug plan through CIGNA that has been pretty decent. Cigna uses Express Scripts to fill prescriptions on this particular plan and I pay one set monthly premium for just over $30. When I order a 90 day supply of medication, I have $0 co- pay. If I order a 30 or 60 day supply, my co- pay is $2. So if I add up the cost of my medication without any drug coverage, this is very reasonable for me. Previously I had subscribed to a Part D plan that had much less expensive monthly premiums and an equally high deductible but my co- pays we’re high enough for the very basic stuff I take and the occasional script for an antibiotic or topical cream that it was ultimately more expensive for me than the CIGNA plan I currently have. I did the comparison on Medicare’s website when it came time to review my plan and have been very pleased. Express Scripts has a decent app and you can do almost everything you need to on line.

    by Barb — July 25, 2022

  22. Thank you so much, Barb for answering my ill-worded question. I realized that I wasn’t very clear.
    Now, I’m very curious what those of us over 65, not on the Advantage plans, need to budget yearly for a drug plan and deductables. I am told that my chemotherapy and transplant rejection medication will be covered under part B medicare, which is good because they are quite costly. What drugs remain are sporadic and minimal. I take a shingles prevention med, an expensive (uncovered) diuretic, other than that, an occasional antibiotic, therefore I believe it is doubtful that I will ever meet those high deductables. This is the first year we have ever really needed any medications.
    So that is my question:
    What are y’all budgeting?
    Thank you

    by Caps — July 25, 2022

RSS feed for comments on this post. TrackBack URL

Leave a comment