1. Not enrolling in a Medigap plan during the Medigap “Open Enrollment Period”
Medigap “Open Enrollment” means you are free to enroll in any Medigap plan available in your state without ANY health questions. This is the first 6 months following the month you enrolled in Part B Medicare.

2. Not analyzing your Part D Prescription Drug Plan
It’s important to check ALL drug plans available. It is crucial you check the plans for your specific list of medications. The total annual cost for a drug plan including monthly premium, copays and deductible can very greatly. You need to look at more than just the monthly premium, you need to check your specific medications copays and plan deductible. The pharmacy you wish to use can also make a difference as there are Preferred and Standard pharmacies.

3. Not analyzing your retiree health coverage
Unless your retiree health coverage is free or very inexpensive, it may not be worth the cost to have retiree insurance as your secondary (supplemental) coverage to Original Medicare. You may be better off getting a Medigap or a Medicare Advantage (Part C) plan that could be less expensive and better coverage to supplement your Original Medicare Part A and Part B.

4. Wanting the same Medicare plan as your neighbor, friend or relative
Medicare is very “individual”. Everyone’s health and medication needs are different. Usually your neighbor, friend or relative will not have the same medical needs as you.

5. Not understanding the difference between Medicare Supplement and Medicare Advantage

Medicare Supplement (Medigap) is additional coverage from a private insurance company that supplements Original Medicare Parts A & B – it fills the gaps. (You still have Original Medicare as your primary insurance provider). There are no networks. Over 90% of providers and most hospitals across the United States accept Original Medicare. If the provider accepts Original Medicare they must also accept your Medicare Supplement (Medigap) plan. Once you are in a Medigap plan you can never be cancelled for health reasons. As long as you pay the premium you will always have the plan regardless of health. The premium for a Medigap plan is usually higher than the premium of a Medicare Advantage plan, however, in exchange for a higher premium is the freedom of no network restrictions, no referrals or pre-authorizations and little if any out-of-pocket expenses (most plans) besides the annual Part B deductible ($233 in 2022).

Medicare Advantage
is when your Medicare Part A and Part B benefits are managed by a private insurance company who replaces your Medicare Part A and Part B with an all-in-one HMO/PPO plan (similar to what you would have experienced with employer group health insurance). Most Medicare Advantage plans include drug coverage. Medicare Advantage plans have copays, coinsurance and deductibles associated with your doctor and hospital visits. HMO plans require you to seeing providers “in-network” only (except for emergencies), and you usually have to get referrals and sometimes pre-authorizations for treatments. PPO plans allow you to see providers “out-of-network”, however, they will charge a higher cost share than they would if you went to an “in-network” provider. The Medicare Advantage plan approves or denies medical treatment, not your doctor. Medicare Advantage monthly premiums are typically cheaper than a Medicare Supplement. There are “zero-premium” Medicare Advantage plans available in most areas. Many plans include extras like preventive dental, vision and hearing coverage, gym memberships, OTC allowance, transportation to doctors and more. Medicare Advantage plans are “one-year contracts” from January 1st to December 31st. Short of moving out of the plan service area or having a life changing event, you are required to stay in that plan until the end of the calendar year until the fall Annual Election Period (AEP), December 15 through October 7, where you can choose to change to a different Medicare Advantage plan or choose to go to Original Medicare. Your new plan would become effective on January 1st of the following year. **IMPORTANT** If you choose to leave Medicare Advantage and go to Original Medicare and you want a Medigap plan, you will likely need to “medically health qualify” to be accepted into the Medigap plan (unless it is within 12 months of trying out Medicare Advantage). It is important that you get approved for a Medigap plan before cancelling your Medicare Advantage plan.

**IMPORTANT** Often people don’t realize, regardless if you have a Medicare Supplement (Medigap) OR a Medicare Advantage plan, YOU HAVE TO PAY THE MEDICARE PART B MONTHLY PREMIUM – $170.10/mo. (in 2022). This amount will automatically be deducted from your Social Security income (if you began taking Social Security benefits before turning 65), otherwise, Medicare will bill you quarterly for the Part B premium.

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