Guest Column: Denver Physician Details 5 Common Medicare Mistakes

For those already on Medicare or anyone who is about to be eligible, one of the best times to reevaluate your plan or sign up for one is during the Medicare Annual Enrollment (AEP) Period, October 15 – December 7. It is during this time that Medicare plan beneficiaries can sign up for benefits, reevaluate coverage, make changes to existing coverage, or adjust policies for Original Medicare, supplemental drug coverage, or Medicare Advantage.

Medicare beneficiaries include persons ages 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). Those who have participated in open enrollment previously know there are a lot of choices when it comes to Medicare. While the most important might be choosing to take charge of your Medicare decisions in the first place, it’s also a good idea to make sure the choices you make aren’t costing you unnecessarily.

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Here are five common mistakes that you don’t want to make during this time – and the reasons why.

1. Don’t allow automatic plan renewal to make your choice for you.

Your Medicare Part D or Medicare Advantage plan renews every year on January 1, unless you decide to change it. Automatic renewal may make your life easy, but it might not be the best way to make your Medicare decisions. This is especially true if your health care needs have changed in the last year, if you are taking more medications, if you have wished you’d had more benefits, (such as dental or hearing), or if your finances have changed – to name a few considerations. Plans also may change what they cover from year to year, including what you will pay in deductible, premium, copay or coinsurance amounts. This information will be contained in the Annual Notice of Change, which is discussed next.

 2. Don’t ignore your plan’s Annual Notice of Change (ANOC).

Typically delivered to mailboxes by September 30, ANOC letters ensure that plan members have up-to-date plan information before AEP begins. This document explains any changes in your plan benefits and costs for the upcoming year. The changes may affect your health care and your budget, so it’s important to know what to look for in the ANOC, as it can help you decide early whether to keep your current plan or alert you that you may want to look for a new one during the AEP.

3. Don’t base your plan choice on the premium alone.

It is easy to focus only on premiums when looking at Medicare costs, but it’s a good idea to look at the big picture, too.

A plan could have a low monthly premium, then charge a medical or prescription drug deductible or have higher copayments. You might prefer this if you rarely go to the doctor and don’t take many medications, but a plan like this could be expensive if you use health care services often, even with the low premium.

It’s important to think, too, about all the out-of-pocket costs as well as your healthcare needs when choosing a plan. For example, many Medicare Advantage plans offer routine vision, hearing, and dental coverage, and certain plans also provide fitness membership benefits at no additional cost.

4. Don’t pick a plan because your spouse, relative or friend has it.

You might count on a friend’s word when deciding what new restaurant to try, but a Medicare plan is a personal choice. What works for one person may not fit with the needs of another. You will probably have several plans to choose from, so it’s a good idea to look at all your options, keeping your healthcare needs and budget at the forefront of your mind. The Medicare.gov website suggests considering seven things when choosing a plan that’s just right for you: cost, coverage and benefits, any other coverage you hold, prescription drugs, doctor and hospital choice, quality of care and travel coverage.

5. Don’t assume that you don’t qualify for help with Medicare costs.

Several programs offer financial assistance with Medicare premiums and other costs. In some cases, Medicare Savings Programs may pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions.

There are four kinds of Medicare Savings Programs: Qualified Medicare Beneficiary (QMB); Specified Low-Income Medicare Beneficiary (SLMB); Qualifying Individual (QI); and Qualified Disabled & Working Individuals (QDWI). If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get extra help paying for Medicare drug coverage. You may want to look into them, even if you think you might not be eligible.

For full information on enrolling in Medicare plans, you can review the CMS website at www.medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week. You can also contact your State Health Insurance Assistance Program office (https://www.shiphelp.org) to discuss your situation.

Dr. Matthew Lewis is the Senior Medical Director of Primary Care with New West Physicians, part of Optum.