8 MISTAKES TO AVOID WHEN

ENROLLING IN MEDICARE

There is much to be said about getting older and looking forward to retirement. On one hand, we worked hard and deserve to relax a bit and do more of what we love. On the other hand, we have to almost become an expert in order to deal with the endless rules of the Social Security Administration and Medicare.

Medicare is a law that took effect in 1965; it is medical coverage for people 65 years or older or people of any age with certain disabilities. Medicare can be complicated and difficult to understand. It is a good idea to speak to a licensed health insurance agent to help you understand the multitude of coverage options that are available to you, they will also help you avoid life long penalties. Because there is so much information to process and understand, make sure to start looking into your options as soon as you start thinking about retirement. Here are some mistakes to avoid when transitioning to Medicare.

1. If you are working Past 65

Some people choose to work past 65 years of age to take advantage of higher Social Security payments or they simply must continue to work.

If you are planning to work past age 65, or even if your spouse/partner continues to work and covers you on their insurance plan, you should do some research and compare your best options, any cost differences and or restrictions within the Medicare program.

For example, you might be covered under your spouse’s plan and and pay $500+ a month for your coverage alone, In such case, going on Medicare might make a lot more of sense.

Some points to discuss with your agent;

• The cost difference between Medicare and your employer’s coverage.

• Understand which plans offers you the best coverage for your needs as far as copayments and maximum out of pocket amounts.

• Network limitations

• Investigate whether spouse/partner and/or your dependents can remain on your employer's plan if you decide to choose Medicare.

Tip: Compare your employer coverage with Medicare at 65

2.Failing to delay Part B enrollment with Social Security

If you have elected to receive early retirement benefits at age 62, you will automatically be enrolled in Medicare when you turn 65; a red, white and blue card will show up approximately three months before you turn 65; in such case and if you are still working, and after your discuss your current coverage vs Medicare coverage with your agent; if you decide to keep your employer coverage; then you should follow the instructions on the back of your Medicare card to delay part B enrollment. this way , you will not be paying for double coverage unnecessarily.

Tip: Medicare / Medi-Cal Recipients may qualify

for extra benefits

3. Part A, B, C, D which one should I get?

Medicare is the federal health insurance program for: People who are 65 or older certain younger people with disabilities, People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

In simple terms, Part A pays for hospitals stays, skilled nursing etc , most people get that for free by simply working at least 40 quarters and paying Medicare taxes otherwise, it would cost $499.00 a month in 2022. If you do not have Part A, then you have no hospital coverage.

Part B, pays for doctor’s visits, surgeries, labs, examinations, etc. in 2022 It costs $170.50 a month unless you qualify for assistance programs, your local agent can help guide you to what programs you might qualify for.

If you will only have Medicare, then you should enroll in part A and Part B at the Social Security office or on their website, then speak to an agent to get either Part D or Part C plan that includes drug coverage. if you will have other coverages like VA, Medi-Cal or Tri Care for life; then you should discuss what you have with your agent so they can explain how your coverage will work with Medicare.

4. Optional Part B enrollment

One of the confusing issues about Medicare is that Part A is free if you worked the 40 quarters and Part B will cost money; in 2022 most people pay $170.50 per month for it, so a healthy person who does not go to the doctor might be tempted to pass on part B enrollment, then later on in decide to get their annual check up etc. or basic lab exam, now, there is now, not only they have no coverage and must pay the entire cost, but also, they are surprised, with life long penalties if they try to re-activate Part B.

There is also one more hoop to jump, you can't simply enroll in part B anytime you want unless you have a special enrollment period. There are specific times when you can apply to re-activate Part B without a special enrollment period. Therefore, if Medicare will be your only coverage, you should not pass on Part B. Part B late enrollment penalty can last a lifetime. Your monthly premium for Part B may go up 10% for each 12-month period that you could have had the Part B coverage but chose not to enroll in it. Talk to your agent to explain the possible penalties and if any of it would apply if your case.

Tip: Drug cost assistance programs can limit co-payments on prescriptions to as little as $3.90 per prescription

ask your agent to help you apply

5. Optional Part D enrollment

Part D covers your prescription drugs and like part B, If you choose to pass on the coverage now and you have no other creditable coverage elsewhere, you may be charged a late enrollment penalty that is permanently added to your Part D premium should you need it later on in your lifetime. Drug plans can be as little as $10 a month. if you have no other drug coverage; you should not pass on part D even if you take no prescription drugs.

Also, do not buy the same Part D plan that your spouse or your neighbor has simply because it is working for them, Instead you should shop for part D plans based on the prescription medication list that you use and the preferred pharmacy in your area. Usually, you will have at least 25 different drug plans to choose form, therefore, comparing formulary lists and copayments is essential.

Do not buy the drug plan simply based on the name of the insurance company name either, because their plan might not be the best for you. Your agent should be able to run your drug list and recommend the drug plan that suits your needs.

One more thing to remember; shop for your part D plan every year during the Annual Election Period (AEP) that is October 15th to December 7th, as the formularies change every year and what worked great this year may not be the best option next year.

6. Taking advantage of guaranteed issue rights for Medicare Supplements / Medigaps

A Medicare supplement or Medigap plan will pick up where Medicare stops and will be accepted anywhere Medicare is accepted. If you are transitioning to Medicare, and you have a serious Medical Condition with a special needs to see certain doctors and certain facilities all over the place; then consider a Medicare Supplement sometimes called Medigap plan and buy it within the first 6 months of Part B effective date. This may be your only chance to get one, as during that time, you have what is called Guaranteed issue right, that means when you apply for a Medigap plan, the insurance company must accept your application and can not ask any medical questions or deny based on a preexisting condition. It is also important to shop for one, as the supplement policies can vary to over $200 per month between different companies for the exact same coverage.

7.Choosing the right Part C plan also known as Medicare Advantage Plans

Medicare advantage plans are another great way to get coverage for Medicare with lower or even Zero monthly premiums, there are many types of advantage plans available and they will depend on the where you live as these plans are county specific.

Most advantage plans will have the drug coverage included within the plan and some may offer many other extra benefits otherwise not covered by Medicare, like routine hearing exams, hearing aids, dental and vision coverage, some might have gym membership and over the counter benefits.

However, when discussing these plans with your agent make sure to have him/her check to see if your current doctors are in the plan network to avoid paying higher copayments or even the entire cost of the visit or medical service.

8.Four reasons to work with a local independent agent

There are many ways you can get your Medicare Coverage, we advise our family to talk to a local agent, who is independent and specializes in Medicare, we will share some industry insights with you.

First; working with a local agent will not cost you any more or less than if you call the company directly, it will however add a local contact person that can help you resolve issues that may come up in the future.

Second: work with an independent agent not a captive agent. An independent agent can shop multiple companies to compare coverage options, vs a captive agent working for X company can only offer X company plans.

Third: You should not buy a plan because it worked for your spouse or friend, Medicare plans can vary greatly and one size does not fit all, for example, if you are diabetic, have heart problems, high blood pressure or even high cholesterol, you might benefit from a special needs plan vs a regular plan. A local agent will be familiar with the plans available in your county, unlike an agent in a different state who might have relationships with a handful of companies and not necessarily all the plans available in your area; therefore, working with a local independent agent can be a lot more beneficial than you think.

Fourth: When you buy on-line, you are really buying from one company, you short yourself on shopping and comparing other options that might serve you better.