AARP Hearing Center
Key takeaways
- Medicare enrollment is not automatic for everyone, and missing deadlines can lead to coverage gaps and lifelong penalties.
- Original Medicare and Medicare Advantage offer different benefits, provider access and prescription drug coverage options.
- Reviewing coverage annually can help avoid higher costs and unexpected changes to benefits or networks.
Summary
Medicare enrollment can be confusing, and Medicare mistakes may lead to penalties, coverage gaps or higher health care costs. Tricia Sandiego outlines five common pitfalls, including assuming enrollment is automatic, overlooking differences between plan types and missing Special Enrollment Deadlines after leaving employer coverage.
The discussion also highlights the importance of identifying coverage gaps, considering Medigap and assistance programs when appropriate, and reviewing Medicare coverage every year. Taking time to understand plan options and enrollment periods can help people make informed health care decisions and avoid costly surprises.
The key takeaways and summary were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
Full transcript
[0:00] Whether you’re enrolling in Medicare for the first time or assisting a loved one, it’s easy to get confused about when to enroll and which plan to choose.
[0:09] And unfortunately, a simple mistake with either of these can be costly and permanent.
[0:15] So let’s look at the five most common Medicare mistakes to avoid.
[0:20] Mistake number one: assuming Medicare enrollment is automatic.
[0:25] It’s not for everyone.
[0:27] The sweet spot to start looking into enrollment is age 64½, because as you approach 65, you have a seven-month enrollment window, which starts three months before the month you turn 65 and ends three months after.
[0:42] Missing this window not only could mean a gap in coverage but could also mean penalties, including one that’s added to your premium for life.
[0:50] That’s money out of your pocket that could go towards your health care.
[0:54] OK, mistake number two: assuming all Medicare plans are created equal.
[1:01] They’re not.
[1:02] Original Medicare is different from Medicare Advantage, so you need to do your homework to figure out which works for you.
[1:08] For example, Original Medicare allows you freedom to choose any doctor or hospital in the U.S. that accepts Medicare.
[1:15] But if you want a prescription drug plan, which is highly recommended, that’s separate, and it does not include coverage for routine dental, hearing or vision care.
[1:26] With Medicare Advantage, you pay higher out-of-pocket costs, but you have the option to go out of network and prescription drugs are covered.
[1:36] But to pay the lowest prices, you have to stay in-network.
[1:41] Medicare Advantage plans also usually cover things like dental, vision and hearing.
[1:46] Mistake number three: missing your Special Enrollment Period.
[1:51] Say you’re 67 and ready to retire, but you skip signing up for Medicare at 65 because your employer covered your health insurance.
[1:59] Once you leave your job or lose that coverage, Medicare gives you just eight months to enroll.
[2:06] That’s it.
[2:07] And it doesn’t matter if you pick up COBRA or find other coverage in the meantime.
[2:11] That eight-month window still applies.
[2:14] Miss this period, and you’re generally forced to wait for the next open window.
[2:20] That could mean going months without medical coverage or prescription drug benefits.
[2:25] On top of that, there are penalties, as I mentioned before, some for as long as you have Medicare.
[2:32] OK, mistake number four is super important: not finding coverage gaps beforehand.
[2:39] Medicare doesn’t cover everything, so you may need additional insurance for out-of-pocket costs.
[2:45] And once you have that, then you need to know what’s covered and what’s not.
[2:49] Medigap is one solution.
[2:52] It covers things like copays and deductibles, but waiting to buy it is risky, because insurance companies can deny coverage or charge higher premiums for things like preexisting conditions.
[3:05] We have a video about Medigap plans which covers the basics and more here.
[3:11] And if costs are creating coverage gaps, there are programs to help as long as you qualify, like the Medicare Savings Program and the Part D Extra Help program.
[3:21] Both can help with things like high premiums and drug costs.
[3:25] OK, mistake number five is also a biggie: forgetting to check your plan every year.
[3:32] After you enroll in Medicare, be sure to review your coverage every year during open enrollment to make sure it’s still a good fit.
[3:40] If you don’t review your plan, you could face higher costs, find that a prescription is no longer covered, or learn that a doctor is no longer in-network, and you may have to wait for another enrollment period to change plans.
[3:54] We hope this information makes your Medicare experience as mistake-proof as possible.
[3:59] If you have other questions about Medicare enrollment that we didn’t cover, you can find more information by visiting aarp.org/medicare
