What to know when it’s time to enroll in Medicare

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Just like aging, enrolling in Medicare ain’t for sissies

Whether you are enrolling in Medicare for the first time or changing your coverage during annual open enrollment, there are many complex decisions to make. These include the type and level of healthcare coverage you want, how much supplemental coverage you can afford, and if you want to bundle coverage or add a la carte components.

Now is open enrollment season for those who are on Medicare. (You’re eligible to enroll in Medicare three months before and after your 65th birthday month, but outside of that window, Medicare beneficiaries generally can make changes only during the annual open enrollment period). In the latest issue of Consumer Action News, we remind consumers to make coverage changes during the Oct. 15–Dec. 7 open enrollment period. We caution that failing to enroll in some Medicare services when you turn 65—or when you first enroll in Medicare—can expose you to penalty pricing.

Medigap or Medicare Advantage
Your first big decision will be whether to enroll in Original Medicare with a separate prescription drug plan and/or a Medigap supplemental insurance plan, or in a Medicare Advantage plan, which tends to offer a broader range of coverage (dental, vision, drug plan) under one umbrella.

When evaluating your options, you’ll want to consider your overall health, as well as cost. Original Medicare with a Medigap policy (to help with deductibles, copayments and coinsurance) will probably cost you more per month, but will offer access to a much wider range of doctors and can save you money if you have expensive medical issues, but there is no cap on out-of-pocket costs.

Medicare Advantage plans rely on a medical provider network, may require referrals and might limit your expenses with a yearly out-of-pocket maximum outlay on medical bills. Understand the pros and cons of each of these plans in Medigap versus Medicare Advantage.

Financial pitfalls
Know that if you choose to delay purchasing a Medigap plan when you first enroll in Medicare, acceptance into a supplemental plan will be based on your current health status, which may limit your options and increase your costs. Learn more about the financial penalties of postponing enrollment in Consequences and penalties. Also learn about the Medicare Savings Programs available to low-income consumers.

Take the time now to choose the healthcare coverage and costs that best suit your needs.
Medicare.gov offers a host of valuable resources to help you understand your choices [https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf] and weigh your options [https://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf], including free, local, one-on-one counselors offering guidance about Medicare eligibility, coverage changes and costs in every state. Find your local State Health Insurance Assistance Program (SHIP) online or call 877-839-2675.

“As someone who has Medicare coverage, I can understand the confusion eligible individuals face,” said Linda Sherry, Consumer Action's director of national priorities. “It takes focus to get all the bits and pieces to line up and to get the coverage that’s best for you. Our primer is designed to help jumpstart the process.”


Consumer Action has been a champion of underrepresented consumers nationwide since 1971. A nonprofit 501(c)(3) organization, Consumer Action focuses on consumer education that empowers low and moderate-income and limited-English-speaking consumers to financially prosper. It also advocates for consumers in the media and before lawmakers to advance consumer rights and promote industry-wide change.
By providing consumer education materials in multiple languages, a free national hotline, a comprehensive website (www.consumer-action.org) and annual surveys of financial and consumer services, Consumer Action helps consumers assert their rights in the marketplace and make financially savvy choices. More than 6,000 community and grassroots organizations benefit annually from its extensive outreach programs, training materials and support.




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