Choosing the right Medicare plan when you turn 65 can be a daunting process! Here you can learn about 10 Medicare mistakes to avoid when choosing a plan.

10 Medicare Mistakes to Avoid When Choosing a Plan

10 Medicare Mistakes to Avoid

It’s easy to make mistakes that can affect your healthcare for years to come.

But understanding these common pitfalls can help you make a more informed decision.

1) Overlooking Medi-Share 65+ 

Many people never consider alternatives like Medi-Share 65+, a health sharing program specifically for seniors. 

This plan can offer more flexible benefits compared to traditional Medicare plans, often at a lower cost.

2) Missing Deadlines 

One of the most critical errors is not adhering to enrollment periods.

Missing deadlines can lead to penalties, higher premiums, or a gap in coverage!

Make sure you’re aware of the Initial Enrollment Period (IEP), General Enrollment Period (GEP), and Special Enrollment Periods (SEP).

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3) Getting Tied to a Narrow Network 

Some Medicare Advantage Plans may restrict you to a specific network of doctors and hospitals.

For example, some are regionally focused. Which is great, if you never leave town. But if you want to travel, you may find few or no in-network providers outside of your home state.

If you prefer flexibility, you should consider plans that allow you to see any doctor, preserving your freedom and choice.

4) Getting Locked Out of Top-Tier Hospitals and Clinics 

When selecting a plan, consider whether it allows access to top-tier hospitals and specialists.

If you have a need, can you go to the Mayo Clinic, the Cleveland Clinic, or other tier- one hospitals and have your care treated as in-network?

This is particularly important if you have specific health conditions that require specialized care.

5) Ignoring Travel Plans 

If you travel frequently, consider a plan that provides coverage outside your home state or even internationally.

For example, Medigap Plan G includes significant foreign travel benefits, as does Medi-Share 65+. But most Medicare Advantage plans restrict coverage to the United States.

6) Not Comparing Plans Annually 

Health needs and Medicare plans can change annually.

Review your plan each year with a Personal Benefits Manager during the Open Enrollment Period to ensure it still meets your needs and budget.

7) Underestimating Out-of-Pocket Costs 

Don’t just look at the premium.

Consider deductibles, copayments, and coinsurance. These can add up, especially if you have frequent doctor visits or need expensive medications.

With Medigap Plan G, your out-of-pocket costs for Medicare Part A and B-covered services are limited to your Part B deductible, which is $240 per year as of 2024.

Medi-Share 65+ is structured somewhat differently. But your out-of-pocket costs for services approved but not paid under Medicare Parts A and B are limited to $500 per household per year.

Medicare Advantage plans, however, can have a maximum out-of-pocket (MOOP)  exposure as high as $8,300 for in-network care, as of 2024.

8) Overlooking Supplemental Benefits 

Some Medicare Advantage plans offer extra benefits like dental, vision, and wellness programs.

For those who are designated as chronically ill, some Medicare Plans have recently been adding additional supplemental benefits, such as: 

  • Pest control services
  • Food and produce assistance 
  • Meal delivery services
  • Non-medical transportation
  • Home modification
  • Service animal support
  • Transitional/temporary supports and services
  • Indoor air quality services and equipment

These benefits are not available with Medigap plans.

Other Medicare Advantage plans offer Special Needs Plans, designed for people on Medicaid who have specific medical conditions or other needs.

These additional benefits under these special needs plans can be a lifesaver for certain people.

Don’t overlook these benefits when comparing plans!

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9) Forgetting about Drug Coverage

Many people purchase a Medigap plan or Medi-Share 65+ health sharing plan assuming that these plans include prescription drug coverage.

They do not – except in limited cases where drugs are prescribed and administered during a hospitalization or in a doctor’s office.

Most Medicare Advantage plans include a prescription drug plan, but not all of them. And the specific drugs on each plan’s formulary can vary.

If you’re in a Medigap plan or the Medi-Share 65+ plan, you should strongly consider purchasing a standalone Medicare Part D prescription drug plan.

If you are in a Medicare Advantage plan, you should check your plan’s formulary and ensure the drugs you may need are listed. You should also see what tier these drugs occupy in the formulary, and calculate your deductibles and other out of pocket costs should you need them.

10) Not Seeking Help for Medicare Mistakes To Avoid 

Fully understanding all your Medicare options is a complex process!

If you’re overwhelmed, consider seeking help from a Personal Benefits Manager to guide you through the process, and help you find the best plan to fit your budget.

Avoiding these common mistakes can lead to better health outcomes and financial stability in your retirement years.

Learn More: The Only Medicare Handbook You’ll Ever Need | Why You Should Use an Independent Agent To Buy Your Medicare Plan | What Are Medicare Excess Charges? | How to Buy an Electric Wheelchair or Scooter on Medicare

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage.