There's no getting around it. Medicare is a complicated program and every decision you make will have consequences – for your health and your wallet. To help you get the most out of your benefits — whether you are signing up for the first time or taking stock of your choices during open enrollment — AARP interviewed experts for their advice on how to get the most out of Medicare.
Mind the calendar
The first and most important step is enrolling on time. Miss that deadline and it'll cost you — potentially for the rest of your life. Your Initial Enrollment Period (IEP) is the time you MUST sign up to avoid hassles. It spans seven months —from three months before you turn 65 until three months after. Here's what you need to know about enrollment timing for Medicare's parts.
Part A. This covers hospitals. Most people don't have a premium, so missing the deadline just means you won't have hospital coverage until you enroll.
Part B. This covers doctor visits and other outpatient services, like blood tests, X-rays, etc. If you don't have health insurance and don't sign up during your IEP, you'll pay almost $6,500 more in premiums over the next 20 years based on this year's $135.50 monthly premium. That's because Medicare will increase your premium by a 10 percent penalty for every 12 months you don't enroll when you should have.
The government penalizes you for not meeting the sign-up deadline because it doesn't want people waiting until they get sick to seek coverage. Insurance programs, like Medicare, only work if healthy and sick people are all in it together.
Part D: This covers prescription drug costs. Miss your IEP time and your monthly premium may be 1 percent higher for each month you aren't enrolled. The average monthly Part D premium for 2019 is $31.83. So, if you don't have good drug coverage and wait 24 months to sign up, you'll pay almost $8 a month more for your prescription drug plan for as long as you have drug coverage.
Choose doctors carefully
You have a doctor who has taken care of you for many years and you want to keep seeing her. You've just retired to a new community and need a physician. You're satisfied with your current provider but would be open to change.
Whether you are new to Medicare or are evaluating your coverage during open enrollment, picking the best doctors for your needs and budget is how you make Medicare work best. Here are three things to consider:
1. Do they accept Medicare? There are several ways a provider can be part of the program:
- Participating. These providers agree to accept what's on Medicare's fee schedule as their full payment from the program. You or your supplemental insurance will still be responsible for 20 percent.
- Non Participating. These providers still take Medicare's approved payment, but they are allowed to charge you 15 percent more than that. This is known as a limiting charge.
- Opt out. Buyer beware. These providers can charge patients whatever they want.
- Medicare Advantage plans have networks of doctors. If you see a provider outside the network, you'll pay more.
2. Interview your prospective doctors
“People get a lot of their information about doctors by word of mouth,” says Deborah Dunn, a gerontological nurse practitioner from Livonia, Michigan. But she advises people to meet a new doctor and listen for what she calls “geriatric sensitivities.” For example:
- Are they asking what's going on in your life, like have you suffered the loss of a child or grandchild? That grief could bring on physical ailments, like trouble breathing.
- Have they asked you what kind of support system you have at home? Do you live alone? Do you feel safe at home?