3 Medicare Enrollment Myths.

Medicare can be deeply confusing, and there are a lot of myths out there about how it works and what works best for a particular situation. Here are three myths that you need to watch out for to ensure that you don’t lose out on important coverage or get hit with big penalties.

Myth #1: I’m automatically enrolled
Unless you’re already getting Social Security or Railroad Retirement Board benefits when you turn 65, you will not be automatically enrolled in Medicare. You need to apply directly with Social Security to get on the books.

You can enroll anytime from three months before your 65th birthday month to three months after, meaning that you have a seven month period in which to choose the right plan for you. Part A is free, so it makes sense to sign up right away.

Of course, if you’re still working you might think that you don’t need Medicare Part B (which isn’t free), so there’s no point in enrolling. That brings us to myth number two:

Myth #2: I can wait to enroll
One thing you don’t want to do when it comes to Medicare is wait. Part A is free, so, again, no matter what your situation it makes sense to enroll right away.

When it comes to Part B, it generally makes sense to enroll as soon as you’re eligible, as making a mistake can be quite costly. Missing your enrollment can mean a permanent 10% annual increase in your Part B premium and a 1% monthly increase in your Part D premiums, which is probably not something you want to deal with.

What if you or your spouse are still working and have health insurance? In this case, check with your current provider to see how they work with Medicare. It might make sense to postpone — but don’t forget about signing up when you do retire. You’ll have eight months to do so.

Also, as a rule of thumb, if you work for a company with fewer than 20 people, it makes sense to sign up when you’re first eligible. That’s because smaller plans are allowed to drop you once you’re eligible for Medicare, and they might even refuse to pay Medicare-eligible claims.

If you’re retired and have health coverage, sign up anyway. This applies even if you have COBRA, a retiree health insurance plan, or veteran’s benefits. All of these plans become secondary plans once you’re signed up — and none of them exempt you from the late-enrollment penalties.

Myth #3: Once I’ve signed up, I’m done
While Parts A and B cover a fair amount, neither has out-of-pocket limits. That means that the 20% of costs you’re responsible for under A and B could add up to a lot of money should you need extensive treatment. This is the main argument for getting Medigap’s supplemental coverage or signing up for an Advantage plan.

But even here, it’s important to keep an eye out for gaps in coverage.

The Part D donut-hole is a great example. Part D provides for prescription drug coverage, but once you and the insurance company have collectively paid a certain amount on prescription drugs ($2,960 in 2015), you become responsible for significantly more of the cost — 45% of brand name drugs and 65% of generics. Once your out-of-pocket spending reaches $4,700, the donut-hole closes and you’ll pay a small amount on drugs for the rest of the year.

In other words, take the time to do your homework. Don’t just stop at Parts A and B, and remember to note the deductibles, premiums, and coverage limits in the plans you’re reviewing. Taking the time now can save you a lot of stress down the line.

Individual Health Insurance

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