Know What to Watch Out For
Choosing a Medicare plan is one of the most important health decisions you’ll make. The right plan can help you get the care you need without breaking your budget, while the wrong one can lead to unexpected bills or limited coverage. Because there are several parts and options, it’s easy to make a choice that doesn’t fit your needs. Read on for tips on how to avoid making mistakes when choosing a Medicare plan.
1. Not Comparing All Available Plans
One of the biggest mistakes people make is choosing the first plan they come across. Many assume that all Medicare plans are about the same, but they can vary greatly in costs, provider networks and covered services. Failing to compare plans means you might pay more for the same coverage or miss out on benefits like dental, vision or hearing care. Use the official Medicare website or a trusted advisor to compare premiums, copays and coverage details side by side.
2. Ignoring Total Out-of-pocket Costs
It’s tempting to focus only on a plan’s monthly premium, but that’s just one piece of the puzzle. You also need to consider deductibles, copayments and coinsurance. A plan with a low premium might look great at first, but if it comes with high out-of-pocket costs, it could end up being more expensive overall. Review the plan’s maximum out-of-pocket limit, which is the most you’ll have to pay in a year for covered services.
3. Assuming Your Doctor or Hospital is Covered
Not every Medicare plan works with every doctor or hospital. Some Medicare Advantage plans use networks that limit where you can go for care. If you have a trusted doctor or specialist, make sure they’re in the plan’s network before you sign up. You can check this by contacting your doctor’s office or the insurance company directly. If you travel often or split your time between two homes, look for a plan with a wide network or one that includes out-of-area coverage.
4. Overlooking Prescription Drug Coverage
Prescription medications are a major expense for many older adults. Skipping this step can be costly. Without drug coverage, you could end up paying full price for your medications and you may face a penalty if you try to add on this coverage later. Always review each plan’s drug formulary (the list of covered medications) to make sure your prescriptions are included and affordable.
5. Forgetting to Review Annual Changes
Even if you’re happy with your current Medicare plan, it’s important to review it every year during open enrollment. Insurance companies can change their networks, costs and coverage from year to year. If you don’t check the changes, you might find that your medications are no longer covered, or your doctor is no longer in-network. Reviewing your Annual Notice of Change each fall ensures you’re not caught off guard by higher costs or reduced benefits in the new year.
6. Missing Enrollment Deadlines
Medicare has specific enrollment periods. Missing these windows can lead to late penalties or even gaps in coverage. Your Initial Enrollment Period starts three months before you turn 65 and lasts for seven months total. After that, the Open Enrollment Period (October 15 to December 7 each year) allows you to make changes to your plan. If you forget to sign up on time, you may face higher premiums for the rest of your life or have to wait months before your coverage begins.
7. Not Considering Future Health Needs
Many people choose a plan based on how healthy they feel today. But your health can change over time and a plan that fits you now may not be ideal later. Think about potential future needs, such as hospital stays, specialist care or expensive medications. A plan that offers more comprehensive coverage may cost a little more now but could save you money and stress down the road.
8. Ignoring Extra Benefits and Support Services
Some Medicare Advantage plans offer extra perks like transportation to appointments, fitness programs or telehealth services. While these shouldn’t be the only reason you pick a plan, they can improve your quality of life and make care easier to access. Look at all the benefits offered and decide which ones matter most to you.
What to Look for When Choosing a Medicare Plan
When evaluating your options, keep these key points in mind:
- Comprehensive coverage. Make sure the plan covers hospital care, doctor visits and prescription drugs that you actually use.
- Affordable costs. Look beyond premiums. Consider deductibles, copays and yearly out-of-pocket limits.
- Network flexibility. Confirm that your preferred doctors and hospitals are included, especially if you travel often.
- Drug coverage. Check that your prescriptions are on the plan’s formulary and that your pharmacy is covered.
- Customer support. Choose a company known for good customer service and easy-to-understand explanations.
- Room for future needs. Pick a plan that can grow with you as your healthcare needs change.
Selecting a Medicare plan isn’t just a one-time task. It's an ongoing decision that affects your financial and physical well-being. Take the time to review your options carefully, compare plans each year and seek help from a Medicare advisor if you feel unsure. The right plan can bring peace of mind and protect your health for years to come.