Nine Tips for the Daunting Task of
Signing Up For Medicare
Enrolling in Medicare is a ‘daunting
task’ even for a consumer reporter who has written about
By Caroline Mayer, Kaiser Health News
7, 2015 - “Welcome to America's hottest talk line. Ladies, to talk to
interesting and exciting guys free, press 1 now. Guys, hot ladies are
waiting to talk to you…" Wait! I thought I was calling Social Security
to ask a question about enrolling in Medicare.
It's the first hour of my mission
to sign up for Medicare and already I'm making mistakes. In this case,
it's minor (and amusing), misdialing the toll-free number by one digit.
But it serves as a warning: There are many missteps I can make, some of
them serious, if I'm not careful.
Even for me, a consumer reporter
who has written about health-insurance issues, enrolling in Medicare is
a daunting task. The terminology is confusing and the options are
seemingly infinite, based on the amount of promotional material that's
begun arriving in my mailbox. The letters from various insurance
carriers began appearing exactly six months before my 65th birthday and
after three months they weighed 1.5 pounds. More packets arrive daily.
Medicare experts tell me I can thank the data brokers for the onslaught:
Names and birth dates are for sale to anyone.
Enrolling is a task I'd like to put
off, but I can't. I no longer have job-based insurance, and my current
health insurer has notified me that my policy will soon expire, on the
first of the month in which I turn 65.
I know that the decisions I make
may differ from those made by friends, relatives and even my husband.
Yet we share many of the same frustrations in the sign-up process. For
anyone in a similar situation, here are some of the lessons I've learned
since I embarked on my Medicare sign-up mission.
Just do it!
Yes, Medicare is complicated, but
turning 65 is the time to deal with this. The government will not
automatically enroll you, unless you are already drawing Social Security
You may be like many people who
have chosen to delay receiving Social Security payments until at least
age 66 to ensure the full monthly payout. But you'll be sorry if you do
the same for Medicare, because there's a very strict enrollment period
that runs from three months before your birthday to three months after
you turn 65. If you miss that, you will be penalized, unless you have
health insurance through your job or your spouse's job.
First stop: Medicare, with its
helpful Medicare.gov website and its "Medicare
and You" booklet, available through the mail or online. Medicare is
also easy to reach by phone (as long as you dial correctly) at
800-MEDICARE. If there's a long wait to talk to a representative, you
can leave your number and someone will call you back. Really. It worked
Unless you understand how Medicare
is structured, you may not be able to make good decisions about what
you're buying. These are some of the terms you might see:
Part A of traditional Medicare covers inpatient hospital services,
skilled nursing home care and hospice, among other things.
Part B of traditional Medicare helps cover preventive care and
physician and outpatient services, among other things.
Part D plans are private insurance plans covering prescription drug
Medicare Advantage is an alternative to traditional Medicare. In
this program, private insurance plans are paid by the federal government
to provide coverage that is equivalent to original Medicare.
Medigap plans supplement traditional Medicare and help pay some
out-of-pocket costs, such as co-payments and deductibles and sometimes
emergency medical expenses overseas. These policies are optional, but if
you want one, you're best buying it when you sign up for traditional
Medicare. Otherwise, you won't be guaranteed coverage and may be subject
to medical underwriting, through which you could be denied coverage or
charged a higher rate for preexisting conditions.
You may be in for a surprise if
you're among the many baby boomers I've encountered who believe Medicare
is free. It's not. Not only is there an annual deductible ($147 for Part
B in 2014), but there are also monthly premiums, ranging from $104.90 to
$335.70 for individuals. (The exact premium is pegged to your income,
generally based on the tax return you filed two years earlier.)
If you don't sign up in your
initial enrollment period or when your job-based coverage ends, you will
pay a penalty that will raise your premiums for Medicare Part B and Part
D for the rest of your life. Every year you delay signing up for Part B,
your monthly premium rises by 10 percent -- and missing the deadline by
just one month is considered a one-year delay.
There is also a waiting period for
the coverage to kick in, so you could be without any insurance for
several months, perhaps even a year, if you miss the deadline. For Part
D, the penalty is 1 percent for every month's delay. So a year's delay
would add 12 percent to the monthly drug premium base, currently set at
Don't make assumptions.
Perhaps the biggest mistake you can
make is assuming that your health insurance will stay the same when you
turn 65. Retiree plans can end, and even coverage from some workplace
plans ends, especially if you or your spouse is employed by a
firm with fewer than 20 employees. You also need to apply for
Medicare at 65 if you are on COBRA, the program that allows you to
purchase health coverage offered by your employer if you've been laid
off. You also need to apply even if you are entitled to the military's
Tricare coverage for life.
Don't rely solely on advice from
your spouse or close friends. "You need to look at your own medical
needs: doctors, hospitals, drugs," advises Jennifer Whittaker,
operations supervisor for Allsup Medicare Advisor of Belleville, Ill., a
company that provides enrollment advice for a fee.
'Open enrollment' may be a
Once you've signed up for Medicare,
you should be notified each fall about an open season that allows you to
switch plans. But the open enrollment period allows easy switching only
for certain plans, not all of them -- and that may affect what you do
when you turn 65.
Open enrollment does not give you a
free pass to move from one Medigap plan to another, for instance.
Although some plans (and some states, like New York) do guarantee the
ability to make a change, Medicare allows plans to evaluate your health
if you try to switch. So if you've developed an illness, you may be
rejected or face a sharp rate increase. (If you stay with your existing
plan, your rates can always rise -- but only if they are rising for the
plan or group as a whole.)
"If you didn't pick a benefit you
wanted initially, you may not be able to get it in the future," says
Diane Omdahl, co-founder of 65 Incorporated, another for-fee consulting
firm based outside Milwaukee.
That's also the situation you could
face if you want to change from a Medicare Advantage plan to traditional
Medicare with a Medigap plan. One of Omdahl's clients who was on a
Medicare Advantage plan recently developed diabetes, and he concluded
that switching to traditional Medicare with Medigap would work better
financially. But his diabetes kept him from finding an affordable
Medigap plan. If he had signed up for traditional Medicare with a
Medigap plan, he would not have been charged extra when he subsequently
So what does open enrollment really
mean? If you're on a Medicare Advantage plan, you can switch to another
plan. You can also switch Part D drug plans annually. And since both
Medicare Advantage and the drug plans change premiums, benefits and
providers regularly, it's important to review your plans yearly.
Consider your health over the
long term, not just how you feel now.
Since it may not be easy to switch
Medigap plans in the future, many Medicare advisers suggest that if you
are choosing a Medigap policy, buy the best coverage you can afford when
you sign up.
The cheapest price is not
Consider more than the cost of the
premium when you sign up for a Medicare Advantage or Medigap plan. Look
at co-payments and deductibles, too. The cheapest premium might not
provide you with the cheapest overall plan. Also, review a company's
complaint records as well as its financial stability to hopefully ensure
that it will be around as long as you plan to be.
For Medicare Advantage plans and
drug plans, the Centers for Medicare & Medicare Services (the agency
that runs Medicare) provides a helpful five-star rating system based, in
part, on member satisfaction surveys.
Customer satisfaction ratings for
Medigap plans are harder to find, but one valuable site for me was
Missouri's Complaint Index for Medigap issuers. (Many of the
companies on this list operate nationwide.)
Several companies rate the
financial strength of insurance carriers, although you may have to pay
to get information. Two of the most frequently cited rating firms are
Weiss Ratings and
A.M. Best, neither of which charges for basic information.
Make calls and ask questions;
you'd be surprised by what you learn.
Once you pick a plan, call and
confirm its different points, such as the premium and out-of-pocket
limits," Omdahl advises. "It's rare, but sometimes the information
online isn't accurate."
You may also discover added
discounts. After I narrowed my search to two Medigap companies, I
learned that if I went with the plan that my husband used, we'd both get
a 5 percent discount on premiums. None of my research mentioned a
You might also consider seeking
advice from an independent insurance agent. But remember, these agents
typically talk only about the plans they offer - and they usually
receive a commission on the policies they sell.
There's also a growing list of
firms that will help you for a fee. These include:
65Incorporated.com, with a fee of $299 for an initial enrollment
consultation, $499 for a couple.
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