Navigating Medicare can be tricky, with plenty of opportunities to make costly mistakes. Learn the ins and outs so you can avoid the pitfalls!
1. I can always delay Medicare Part B if I have a group plan.
“I work for a small company that provides a group health care plan. I’m turning 65 this year—am I required to enroll in Medicare?” – Lori H. | Tamarac, FL
Medicare rules are different for small companies. If you receive your group health insurance from an employer with less than 20 employees, you must enroll in Part B. Once enrolled, Medicare becomes your primary insurance and your employer group plan becomes secondary. If you’re not enrolled in Part B, you are essentially without primary insurance, and run the real risk of having your group insurance plan deny any claims that Medicare A & B could’ve paid.
2. I won’t need a Part D prescription Plan if I don’t take any medications.
“I am 65, in great health and do not take ANY prescription drugs…can I skip the enrollment in a Part D Rx plan?” – Diane S. | Bonita Springs, FL
Unless you have current creditable drug coverage, Medicare will require that you enroll in Part D as soon as you are eligible. Any gap in coverage of more than 63 days will result in a small penalty for each month that you delay (Although the penalty is small, it can add up over time). You can still choose to skip the coverage, but you will be subject to the penalty down the road should you ultimately decide to enroll.
3. COBRA will cover outpatient care if I’m 65+ but not enrolled in Medicare Part B.
“My former employer agreed to pay for 6 months of my COBRA coverage after I left the company at the end of March. I am 66 years old and have Medicare Part A only. Since Medicare rules allow for penalty-free enrollment in Part B for up to 8 months after leaving my group plan, I decided to wait to enroll (especially since I had COBRA coverage and did not want to pay the monthly Part B premium). To my shock, COBRA refused to pay for my very expensive out-patient breast cancer treatments because I did not have Part B! How could this have happened? I thought I was covered.” – Vanessa H. | Lake Worth, FL
I’m so sorry to hear about your unfortunate situation. Despite your best efforts to get everything right, you have fallen victim to one of Medicare’s most confusing elements: Medicare and COBRA. You are not alone. What most seniors do not realize is that COBRA is secondary to Medicare, which means that it will only pay claims AFTER Medicare pays. Medicare is the primary insurer and must pay first. In your case, COBRA refused to pay because you did not have primary insurance (Medicare Part B). Bottom line: COBRA can and will refuse to Pay Claims Without Part B.
4. Medicare Advantage will always cover out-patient surgery.
“I enrolled in a Medicare Advantage plan when I turned 65. I was very satisfied with this plan for the first 3 years—until I underwent surgery for a painful kidney stone. Imagine my surprise when I received a huge bill for the surgery! There had to be some mistake. I immediately called the insurance carrier and was informed by one of their customer service reps that it was NOT a mistake—that indeed they were charging me for the entire bill. Why? Because my plan did not cover the procedure in an out-patient surgical center. The carrier would only provide coverage for surgery performed in a hospital. I was told, “Read your policy sir”! I have since refused to pay the bill which was put in for collection, ruining my credit. How is this ethical?!” – John. J.
What an awful experience. When it comes to Medicare Advantage plans, you must be aware that they are all different and must be reviewed carefully. Each private carrier sets their own coverage guidelines and policies. This leaves seniors in a “Buyer Beware” position. While it certainly seems unjust, you have no recourse unless this wasn’t disclosed in your policy. You must read the fine print! Advantage plans have many limitations especially when it comes to higher cost care. A Lesson to be learned: Seniors, shop wisely or go with a Medigap plan.
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