There’s a lot on the line when choosing Medicare services, but recent data shows too many Americans aren’t up to the task—and that malfeasance is costing them.
There’s more. The University of Michigan data notes that only 33 percent of Americans bother to use the internet to research favorable Medicare programs that likely meet their needs.
Do Your Homework and Avoid These Damaging Medicare Mistakes
Healthcare experts say a little knowledge goes a long way toward making Medicare choices and avoiding major program errors. They cite these three Medicare moves as the most damaging mistakes.1. Mistaking Medicare Advantage as a Public Health-Only Care Option
One of the most detrimental errors people make is enrolling in Medicare Advantage because advertising describes it as an enhanced version of Medicare. “This is simply not true,” Evan H. Farr, an elder law attorney and founder at Farr Law Firm, P.C., told NTD. “Medicare Advantage replaces traditional Medicare with coverage provided by a private insurer.”In many cases, Medicare Advantage offers reduced or $0 premium costs, along with added benefits such as dental, vision, hearing, transportation, or gym membership. “These benefits draw attention to the product,” Farr said.
In contrast, the trade-offs in the Medicare Advantage product line are often not disclosed, Farr noted. That includes limited provider networks, prior authorization requirements, changing formularies, plan-specific copayments, benefits that change annually, and potential difficulties receiving reimbursement for rehabilitative services, skilled nursing care, home health care, and so on.
2. Focusing Solely on the Plan's Premium Is a No-No
Another common Medicare mistake is shopping for premiums alone. “A $0 premium plan can end up costing thousands more once you factor in your specific drugs and the care you're likely to need, so the premium is really just the sticker, not the price,” Matthew Hoty, CEO of Healthpilot, an AI-enabled Medicare brokerage, told NTD. “Many people try to compare max out-of-pocket, co-pays, and deductibles to approximate which plan may be a good fit, but it's a lot of noise to sort through on your own.”3. Not Paying Close Attention to the Calendar Can Cost You, Too
Medicare recipients also often err in not checking their own drugs and doctors against the plan, since formularies and networks change every year. “Unfortunately, people tend to assume last year's coverage carries over and then get surprised at the pharmacy counter or when they visit their doctor for the first time in the new year,” Hoty said.The same issue pops up when you pick a plan one year and don't review it again for several years.
“Plans change every year and so does your health, so the plan that fits at 65 often doesn't fit at 68, and skipping the annual review quietly costs people both money and access to care,” Hoty said. “This can compound into thousands of dollars and, worse, into care disruptions that hit right when someone is most vulnerable.”
Some Mistakes Can Be Fixed, and Others Cannot
Correcting Medicare errors isn’t easy, due to the program’s finely tuned structure and timeline, but some mistakes can be rectified.“Medicare offers Special Enrollment Periods for certain circumstances, including losing qualifying coverage, some administrative errors, certain emergency situations, and other specific events defined by CMS,” Geoff Schmidt, CPA and RSSA at HolySchmidt.com, told NTD.
If one circumstance applies, the penalty can go away. If you simply missed the deadline, you can sign up during the General Enrollment Period, from January 1 through March 31, and you will incur the penalty. “You can appeal a late enrollment penalty if you believe it was applied in error, but the outcome can vary depending on the situation,” Schmidt noted.
The best path forward is to get help before you file, not after. Free, independent counseling is available through your State Health Insurance Assistance Program at SHIPHelp.org, and every state has one.
“Independent Medicare advisors can compare options across carriers, which matters because the choice between Original Medicare with a supplement and Medicare Advantage is difficult to reverse later once Medigap underwriting is back in play,” Schmidt added.
Also, your doctor is usually not the best person to ask about Medicare, and most general financial planners don’t work on Medicare rules daily. “The single most useful thing a new enrollee can do is talk to someone whose job is Medicare, and do it three to six months before turning 65,” Schmidt advised.