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Navigating the Medicare Maze

Steps you can take to avoid penalties, gaps in care

by Marsha Mercer, AARP, March 14, 2017

New Report Finds Medicare Enrollment Can Be Confusing

Yagi Studio/Getty Images

Too many people with Medicare struggle to navigate the complexities of the Medicare program.

En español | Deciding when to enroll in Medicare Part B can be confusing, especially for people covered by employer health insurance at 65, and mistakes can be costly, a new report by the Medicare Rights Center warns.

The national advocacy group analyzed 16,000 calls to its consumer helpline in 2015 and found many callers did not understand how to enroll in and navigate Medicare Part B, which covers outpatient and doctor visits.

Other major areas of confusion: what’s covered under Medicare Advantage and how to afford the rising costs of prescription drugs under Medicare Part D.  

“This analysis of our national helpline data makes clear that too many people with Medicare struggle to navigate the complexities of the Medicare program and to afford their coverage,” said Joe Baker, center president.

The report, “Medicare Trends and Recommendations: An Analysis of 2015 Call Data from the Medicare Rights Center’s National Helpline,” recommends laws requiring earlier and more detailed information to newly eligible Medicare beneficiaries, as well as other policy changes. 

Ten thousand boomers a day sign up for Medicare. But, “starting Medicare has never been as simple as signing up when you turn 65,” says Consumer Reports. “If you time your enrollment wrong you can end up paying extra money for Medicare for the rest of your life – or paying for parts of Medicare that you may not need.”

Here is what you need to know before you apply:

  • People who fail to enroll in Medicare Part B when they first should will face lifetime penalties, a coverage gap and disruptions in care. The penalty is hefty: an extra 10 percent for each full year you could have had Part B but didn’t apply and were not covered beyond 65 by health insurance from a current employer. For more information, see the AARP article “When Does the Part B Penalty Clock Start Ticking?’
  • If you have primary coverage through a current employer (your own or your spouse’s), you can delay Part B without penalty until the job ends. If your coverage is from a small employer (fewer than 20 employees) or a former employer, find out how it works with Medicare. Check out the AARP article “Medicare When Working Beyond 65” to avoid complex problems that can arise in coordinating Part B and an employer’s plan.
  • You need to master the alphabet soup of Medicare – Parts A, B, C and D. Medicare.gov has a primer or watch a six-minute video by a Medicare trainer on Parts A and B.
  • Medicare doesn’t cover everything. Decide whether traditional (also called original) Medicare and a supplement Medigap plan or a Medicare Advantage plan, which combines Medigap and prescription coverage, is best for you. Learn more about Medicare Advantage plans and search for a Medigap plan here. To understand the differences between the two programs, go to the AARP article “Medigap or Medicare Advantage?”
  • Understand Medicare enrollment periods – Initial, Special, General, Open and Medigap Open. The National Council on Aging has a handy guide at this link.  For more detailed information, see the AARP article “Different Medicare Enrollment Periods.”

Medicare

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  • You may qualify for financial help for Medicare. Find out here: 
  • Sign up for Medicare by calling Social Security at 800-772-1213, online, or at your local Social Security office. Call Social Security for an appointment.