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Medicare Enrollment: 5 “Must Do” Actions & 10 Costly Mistakes To Avoid

Whether you’re a current Medicare enrollee, a newly-eligible Baby Boomer and someone helping older beneficiaries choose plans, with Medicare open enrollment underway, it’s important that you take the time to research your options and not simply sign up for the same plan you had in 2010. Use these 15 tips from the experts at PlanPrescriber.com to make the best choice for you.

5 Must Do Actions

A little research will go a long way to finding the best plan for your needs:

1. Pay attention to the drug limitations in your plan. Medicare plans offering prescription drug coverage may place limits on how an individual medication is covered. Because these limits are typically set for individual medications, it’s vital not to assume that your drug is covered. Some drugs may only be covered with prior authorization from the health plan representative, step therapy (requiring that your physician must try other less expensive alternative meds first) or in certain doses and quantities (i.e. while 10 milligrams of Lipitor per month is covered, your 100 milligram prescription is not). For more information about drug limitations you can visit a site like PlanPrescriber at www.planprescriber.com/medicare-part-d/drugs/limits/

2. Get to know the "donut hole." Affecting over 3 million Medicare beneficiaries each year, the donut hole occurs when enrollees reach $2,830 in drug costs and must pay 100 percent of their medication costs until their out-of-pocket Rx expenses hit $4,550. These guidelines are for 2010; with health reform, this coverage gap will begin to close every year until it is closed entirely by 2020. Some good news for this year, though: in 2010, under reform, if you reach the Donut Hole, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help. These checks began being mailed to beneficiaries in mid-June 2010.

To help you with the donut hole in 2011:


3. Check the formulary changes to your prescription drug plan to ensure that your medications are still covered. It is very important to check your Medicare Part D Prescription Drug Plan each year because insurers may change what medications are covered and which drugs are not. When enrolling in a Part D plan for the first time, check to make sure the policy covers your medications. In addition, current enrollees should review the new Part D plans because many are available with lower cost sharing, premiums and/or deductibles. Use a Medicare Prescription Drug Plan comparison tool like the one available at PlanPrescriber.com to compare premiums, deductibles, drug coverage and estimated annual costs. You may be able save hundreds of dollars by switching your drug coverage.

4. Consider whether you will require a Medicare Supplement, or Medigap, plan in early 2011 to balance out your needs. Medigap has its own open enrollment period, beginning the day you turn 65 and lasting six months. Prior to enrollment, decide how much coverage you need and understand how the premium is calculated. To help you, here are a couple tips:

  • Evaluate your current health status and your potential health needs in the future, especially if budget is a concern. If you are looking for a more comprehensive plan with lower co-pays and lower co-insurance, it may be more expensive. A plan with basic benefits may give you the coverage and the peace of mind that you need at a lower premium.
  • Each insurer decides how to set the premium for its Medigap policies by community rating, issue-age rating or age-attained rating. How the premium is set will affect how much you pay now and in the future.


5. Don’t get caught paying a Medicare enrollment period penalty. It is important to note when you must sign up for Medicare Parts A, B, and D. In some cases, if you do not sign up within the proper time period, you may have to pay a penalty. To avoid paying penalties, take the following steps:

  • For Medicare Part A (Hospital), contact Social Security three months before you turn 65, and if you need to sign up for Part A, do so when you first become eligible during the Initial Enrollment Period.
  • For Medicare Part B (Medical), don’t forget to sign up during the Initial Enrollment Period.
  • For Medicare Part D (Drug), join a Medicare Part D plan when you first become eligible, and do not go more than 63 days in a row without a Medicare drug plan or other creditable coverage.

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

The plan that my have seemed perfect when you signed up might not covered your needs for next year. Avoid making these errors:

  1. Missing the "fine print": Not reading the fine print in your annual plan Notice of Change about which benefits have changed and which have remained for your plan can be costly.
  2. Going on auto-pilot: Not doing anything and simply auto-enrolling in the same plan is a potential mistake. Many plans change cost 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. 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, co-pays 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 this plan.
  4. Not asking for help: Not asking for help from qualified professionals in understanding and selecting a plan or using tools to evaluate prescriptions means you might not be getting the best plan. You can get help through your State Health Insurance Assistance Program (SHIP), PlanPrescriber, licensed health insurance agents who are certified to sell Medicare, family members 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. 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. My drugs are covered: Don’t assume your doctor knows what is in your network or what prescriptions are in your formulary. You can enter your current medications on a website like http://www.PlanPrescriber.com 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 providers.
  8. Medigap has me 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 "medically necessary" or a Medicare covered benefit, neither will the Medigap plan.
  9. I’ll qualify: 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.
  10. I’m covered worldwide: Don’t assume Medicare covers you when traveling outside of the United States. Medicare will not pay any medical claims outside the US and its territories. However, certain MediGap plans might extend emergency coverage outside of the US.