COLUMN: Top mistakes Medicare counselors see
Last month we asked ChatGPT to tell us the most common mistakes people make with their Medicare. Those mistakes are real.
Now, though, let’s review eight mistakes, misconceptions and miscalculations that Medicare counselors encounter. Although some can be costly mistakes, others are miscalculations that result from habit of just not knowing one’s options.
A Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor could help you with these and other Medicare-related questions. You will find details about how to make a SHIBA appointment at the end of this column.
OK, here are eight:
Failing to annually compare insurance costs: Medicare beneficiaries with Medicare Advantage insurance or prescription drug plans may annually compare premium costs and benefits during open enrollment, Oct. 15 through Dec. 7, and change plans if they wish to do so. Those with Medicare supplement (Medigap) policies may do so at any time and, if they wish to change, may do so with the protection of Oregon’s Medigap birthday rule. Comparisons for all Medicare insurance may be done on the Medicare.gov website or by speaking with a SHIBA volunteer Medicare counselor.
Enrolling in the same Medicare insurance as your spouse: Medicare beneficiaries do this frequently, perhaps because that’s what they did when they were working and had fewer options. Doing so is not wrong, but people’s health care needs do differ. It’s essential that insurance align with the individual’s health needs, be best at covering the person’s prescription drugs, and be a plan or policy that the doctor can bill.
Believing that an insurance plan is better because it’s costlier: With Medicare supplement (Medigap) insurance, monthly premiums can vary by $100 or more yet the coverage is the same within a policy type (Plan G, for example). With Medicare Advantage (MA) insurance, out-of-pocket co-pays will be less with a more expensive plan, although how much the insurance is used will determine whether paying a higher premium is justified. With some MA plans, setting aside the difference each month between a no-premium plan and one with the higher premium might pay the free plan’s higher copays (it’s easy to calculate).
Allowing a gap in health care coverage: It’s surprising how many people are somewhat cavalier about starting Medicare or Medicare insurance to correspond with the end of prior coverage such as employer insurance or Medicaid. Incurring a major medical event during that gap in coverage could be bankrupting.
Buying insurance from a television advertisement: TV ads are so short that they can be unintentionally misleading, such as those that seem to promise cash savings available to only a few beneficiaries. It’s essential that a Medicare Advantage plan cover the person’s prescription drugs, and that they have the person’s doctors in network so the plan can be billed. Although a TV commercial might be helpful, it cannot know your circumstances.
Not learning how to use the Medicare.gov website: Almost everyone has access to Medicare’s website on a phone, tablet or computer. The website’s intuitiveness varies by individual. Learning how to use the website – a SHIBA Medicare counselor can easily teach this – means that at any time you could independently compare the price and benefits of Medicare Advantage plans, Medigap policies or prescription drug plans.
Skipping drug insurance because you have no prescriptions: This seems a mistake on four counts. First, if you fail to enroll in drug insurance, but later do enroll, you will pay a lifetime financial penalty, although this penalty is minor unless the delay goes on for years. Second, if you’re prescribed a drug without insurance you’ll be paying its full cost at the pharmacy. Third, if you later need drug coverage you’ll have to wait until Oct. 15-Dec. 7 open enrollment to enroll, with coverage beginning Jan. 1. Finally, having drug insurance can cost nothing because a few plans charge no monthly premium. (Medicare beneficiaries with VA drug insurance may skip enrolling in a Medicare drug plan.)
Not scheduling an annual wellness visit: “Free is a very good price” is a line we all know. And scheduling an annual Medicare wellness visit with a medical practitioner is free. This visit isn’t as comprehensive as a full physical exam, and is intended to identify a patient’s risk factors and to deliver education. A wellness visit doesn’t include blood work, although most Medicare insurance fully covers doctor-prescribed blood work. For more about Medicare wellness visits, see page 19 of the Oregon Guide to Medicare Insurance Plans.
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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