COLUMN: The most common Medicare mistakes

Artificial intelligence and Medicare are two concepts that we might never expect to find in the same sentence. But here we are. We asked ChatGPT, “What are the most frequently made mistakes with Medicare?”

Within seconds, the AI platform delivered 10 common mistakes – in no particular order, it said – that it had gleaned from AARP, Kiplinger and other websites.

These 10 are certainly not exhaustive but they are, as they say, a good start.

If you would like help with your Medicare, including avoiding mistakes, consider scheduling a free appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor. Details about how to do so are at the end of this column.

Here’s ChatGPT’s list including tips for avoiding the miscues. The mistake is in boldface, followed by this column’s comment.

Missing the initial enrollment period. For persons wishing to enroll in Medicare as they turn 65, the enrollment period starts three months prior to your birthday month and concludes three months after it. See page 15 of the Oregon Guide to Medicare Insurance Plans.

Assuming Medicare covers all health-care costs. Medicare won’t cover most dental, vision and hearing issues, and most Medicare beneficiaries pay the Medicare Part B monthly premium (currently $185) and part of cost of drugs at the pharmacy. Many also pay a premium for health insurance as well as medical copays.

Not reviewing coverage annually. Medicare beneficiaries are well advised to annually compare their insurance plan or policy annually others in the market, this because sometimes other plans become more competitive (or yours becomes less so). Beneficiaries with Medicare Advantage insurance or a prescription drug plan may do this Oct. 15 through Dec. 7 on the Medicare website; those with Medicare supplement (Medigap) policies may also do this on the Medicare website, and use Oregon’s Medigap birthday rule to protect them in changing policies if they choose to do so.

Overlooking prescription drug coverage. Failing to enroll in drug coverage can lead not only to a lifetime financial penalty, but also proves costly if you’re prescribed an expensive drug without insurance (see page 27 of the Oregon Guide). Monthly premiums for drug insurance start at zero and go up from there.

Choosing incompatible coverage with your healthcare providers. “Cut me a break,” you say. “I’ve figured out how to navigate the Medicare website, entered my prescription drugs, reviewed plans and enrolled.” The missing step here is ensuring that your doctors can bill the insurance you choose. For Medicare Advantage plans, doctors must be “in network” with the insurance. For Medigap policies, doctors must be willing to bill Medicare.

Not understanding the differences between Medicare options. Medicare and Medicare insurance are surprisingly complicated, and here it pays to study up, ask your questions and know as much as possible (including figuring out what questions to ask). Among resources are the Oregon Guide to Medicare Insurance Plans, a SHIBA volunteer counselor or a trusted insurance broker who handles Medicare insurance. (For an excellent comparison of Medicare Advantage plans and Medigap policies, see pages 45-46 of the Oregon Guide.)

Delayed enrollment without creditable coverage. If a person turning 65 has employer health-care insurance that is as good as or better than Medicare (that is, it is “creditable”), then the individual may delay enrolling in Medicare until that insurance ends. But if the employer insurance isn’t creditable, then delaying Medicare enrollment will result in a stiff lifetime financial penalty (the penalty is 10% of the current Part B premium for each year of delayed enrollment). A quick call to your employer’s HR office is all it takes to learn whether Medicare defines your employer insurance as creditable.

Assuming spousal coverage. OK, if you had employer insurance it most likely also covered your family members. With Medicare and Medicare insurance, coverage is for the individual only. Spouses must each have their own Medicare enrollment and their own insurance coverage, if they choose to have insurance. Also, because individual needs can differ greatly, there’s little advantage in spouses enrolling in the same Medicare insurance plan or policy.

Not considering Medigap policies during open enrollment. This is confusing, because “open enrollment” is usually associated with the Oct. 15-Dec. 7 period in which persons may change Medicare Advantage plans or prescription drug plans. Here, ChatGPT is referencing when one first has Medicare Part B and therefore has guaranteed issue for a Medigap policy plus protection against a premium surcharge because of a pre-existing health condition (diabetes, cancer, heart disease, etc.). See pages 16 and 39 of the Oregon Guide.

Overlooking financial assistance programs. Medicare has three income-related benefits that reduce costs. Extra help (LIS) reduces the price of drugs at the pharmacy. The Medicare Savings Program (MSP) pays the Medicare Part B monthly premium (currently $185). QMB pays all Medicare-eligible medical costs, although one still must have prescription drug insurance. (See page 32 of the Oregon Guide.) Surprisingly, large numbers of Medicare beneficiaries who qualify for these programs either don’t know about them or know but don’t apply.

Avoiding these and other Medicare mistakes is why it pays to do your research well ahead of your Medicare start date. Arguably, nothing in life is more important than your health, and making good Medicare decisions supports it.

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.

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