Common Pitfalls

Not understanding the expenses involved with Medicare

When making decisions about Medicare, make sure you understand its costs, which can include:

  • Premiums, a monthly amount that has to be paid whether or not you use medical services. Medicare premiums may be deducted directly from your Social Security Disability Insurance (SSDI) or Social Security retirement benefits.
  • Copayments, a set amount you have to pay for a medical visit or service. The exact amount of the copayment depends on the service you get: Medications, visits to specialists, lab tests, X-rays, emergency room visits, and other services can all have different copayment amounts.
  • Co-insurance, a set percentage of the cost of a visit or service that you must pay.
  • A deductible, a set amount of money that you pay out of your own pocket each year before Medicare begins to pay for certain expenses. Once you have paid the deductible, you do not have to pay it again until the next calendar year.

Learn about programs that may help you with these costs.

Opting out of Part B and Part D without checking if you'll have to pay penalties later

For most people who get Original Medicare, Part B has a $174.70 monthly premium (it could be a bit less; the amount depends on your situation) and Part D prescription drug coverage also has a premium (the amount depends on the Part D plan).

You may want to opt out of Part B and Part D to save money on monthly premiums, especially if you have other coverage and don’t think you need the sorts of medical services and prescription drugs they cover. However, if you decide you don’t want Parts B and D and you change your mind later, you might have to pay large penalties.

You should only think about opting out of Part B or D if you have other coverage that covers the same types of things that Parts B and D cover:

Even if you have other coverage, it might still make sense to keep Parts B and D if you also qualify for Medi-Cal, Medi-Cal's Working Disabled Program, a Medicare Savings Program, or the Part D Low Income Subsidy (also called Extra Help). They may help you pay for Part B and Part D and so your overall coverage is better.

Learn more about getting help paying for Medicare.

Not applying for a Medicare Savings Program and the Low Income Subsidy (Extra Help)

Medicare Savings Programs (MSPs) help people with low income pay Medicare premiums. Depending on the MSP, it may also help with other expenses, such as copayments, co-insurance, and deductibles.

The Low Income Subsidy (LIS), often called Extra Help, helps people with low income and low resources pay premiums, copayments, co-insurance, and deductibles for Medicare prescription drug coverage:

  • For people with Original Medicare, the LIS can help with Part D plan expenses.
  • The LIS can help with Medicare Advantage plans that include prescription drug coverage, sometimes called MA-PD plans.

You may qualify for an MSP or the Low Income subsidy and not know. Many people who qualify for them never apply. Even if you think you won’t qualify, make sure to apply! They can be a big help. Note: If you have both Medi-Cal and Medicare coverage, you may automatically get help from an MSP and the LIS.

If you have any questions about Medicare Savings Programs and the LIS, call the Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222.

Learn more about getting help paying for Medicare and how to apply for it.

Not seeing how your other health coverage interacts with Medicare

If you have more than one type of coverage, one coverage may pay for costs that your other coverage doesn't pay for, meaning you have to pay less out of your own pocket.

Other types of coverage that you can have with Medicare include:

Learn more about how Medicare interacts with other types of coverage.

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