Not Choosing the Best Medicare Options to Meet Your Needs

There are a lot of decisions you have to make about how you will organize your Medicare. Do you keep Original Medicare or enroll in a Medicare Advantage plan? If you stay in Original Medicare, should you buy a Medigap policy to fill gaps in Original Medicare coverage? If you do buy a Medigap policy, which one is best for you? Do you get Part D Prescription Drug Coverage and if so, which plan should you enroll in?

Make sure you have enough information about the different options and plans before making any decisions. Your options will differ in terms of which medical services are covered, how much you have to pay for those services, and what the monthly premiums are. You should look for a plan that covers the medical services and prescription medications that you need, at the lowest cost. Don’t be afraid to ask for help! Call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 for free, unbiased, and accurate advice about your Medicare options.

Not Enrolling in a Medicare Savings Program

Based on your income and assets, you may qualify for a Medicare Savings Program that can help pay your Medicare premiums and costs. You can apply for a Medicare Savings Program at your county’s Department of Health Care Services Medi-Cal office.

Having to Pay Late Enrollment Penalties

There may be penalties for not enrolling in Medicare Part B and Part D when you are first eligible. Read the DB101 sections on Parts B and Part D and plan carefully to avoid these fees.

Not Choosing the Best Part D Prescription Plan for You

It's important to choose a plan that will allow you to get your prescription drugs covered without having to pay high monthly premiums or out-of-pocket costs. You may want to get expert advice on choosing a Part D plan. For help with Part D plans and other options, you can call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. You can also find information online at Medicare's website.

Here are some things to consider when choosing a Part D plan:

  • How much does the plan cost? How much are the monthly premiums, copayments, and annual deductible?
  • Each plan has a list of drugs it covers. Does the plan cover the prescription drugs you need?
  • How much do your prescription drugs cost in this plan as compared to other plans?
  • With this plan, are you allowed to pick up prescription drugs at pharmacies close to you? Can you get your prescriptions in the mail?
  • How does the coverage gap (also known as the donut hole) work in the plan? When do you have to pay all costs for prescription drugs?

Staying in a Part D Plan When the Premiums Increase and are Too High

Each year your premiums may go up for Part D plans. You need to make sure the plan you are enrolled in is still the best plan for you. There may be another one that costs less but still gives the same coverage. You can compare plans online on the Medicare website.

Declining Medicare Part B because of COBRA and Cal-COBRA

People sometimes decline Medicare Part B coverage when they become eligible for it because they feel that they are covered by COBRA or Cal-COBRA. This is a mistake. These continuation coverage protections end when you become eligible for Medicare.

If you stop working and have already become eligible for Medicare, you should enroll immediately to avoid penalties. COBRA continuation coverage does not entitle you to a special enrollment period for Medicare Part B.