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Ten Costly Mistakes to Avoid When Applying for Medicare

The annual enrollment period for Medicare runs through the month of December. For those who have not yet made a decision, here is a list of ten mistakes to avoid, provided by PlanPrescriber, a subsidiary of eHealth, Inc.

10 Costly Mistakes That Seniors May Make During Medicare Annual Enrollment Period

  1. Missing the Fine Print: Don’t ignore the fine print in your annual Notice of Change about which benefits have changed and which have remained the same for your plan in the new year.
  2. Going on Auto-pilot: It may not be the best idea to simply auto-enroll in the same plan. Many plans change their costs and drug coverage annually. What worked last year for you may not work with the same plan this year and could cost you money in terms of higher prescription drug costs and other out-of-pocket expenses. Changes in medication usage can also change what plan offers you the best economic value.
  3. Assuming that Stable Premiums = Stable Coverage: Just because your Medicare Advantage or Part D premium hasn’t gone up doesn’t mean that you are getting the same plan for the same price next year. Deductibles, copayments, and prescription drug coverage are just a few of the benefits that may have changed. Research and find out what the total out-of-pocket cost will be for the new year’s plan.
  4. Not Asking for Help: Qualified professionals can help you understand your options and select a plan, and there are also tools available to help you evaluate your prescriptions. You can get help through your State Health Insurance Assistance Program (SHIP),, licensed health insurance agents who are certified to sell Medicare, or by calling 1-800-Medicare.
  5. Not Getting a Second Opinion: By not shopping around and seeing what other plans are out there, you may be costing yourself more money in 2011. This is an important decision, so take the time you need to make the right choice and understand all of the options available in your area.
  6. Overlooking Extended Care: Don’t assume nursing home care is a covered benefit; it is not. Medicare does not provide coverage for custodial care, assisted living facilities or long term care. However, skilled nursing facilities may be covered following a related hospital stay.
  7. Assuming Your Drugs Are Covered: Don’t assume your doctor knows which prescriptions are in your formulary. You can enter your current medications on a website like to see which drugs are covered on your current plan and compare the projected costs with other plans available in your area. You can print out this comparison and take it with you to see the doctor. Make sure your doctor knows your in-network labs, physical therapists, or durable medical equipment suppliers too.
  8. Assuming Medigap Has You Covered: Don’t assume Medigap plans will pay claims that Medicare won’t. Medicare only pays for medically necessary claims. If Medicare doesn’t pay, either because the service rendered is not a covered benefit or is not considered “medically necessary,” neither will the Medigap plan.
  9. Assuming You’ll Qualify for Medigap: Don’t assume you will automatically be accepted in a Medigap plan outside of Open Enrollment or guaranteed-issue-qualifying events. Medical underwriting does occur. Work with a licensed agent for help.
  10. Assuming You’re Covered World-wide: Medicare will not pay medical claims outside the United States and its territories. However, certain Medigap plans might extend emergency coverage outside of the United States.

Medicare beneficiaries can use PlanPrescriber’s plan comparison function to review every Medicare Part D and Medicare Advantage plan available nationwide, and those interested in plans offered by UnitedHealthcare, Humana and certain other Medicare carriers now have the opportunity to enroll in many of these plans online. Customer support from licensed eHealth agents is available by telephone seven days a week from 5am-5pm Pacific Time at 888-832-5927, TTY 888-407-5794. Medicare beneficiaries using PlanPrescriber can also contact licensed agents and representatives for personal assistance by email or online chat.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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