Turning 65? Retiring soon? Thinking about changing your Medicare plan? Medicare enrollment can feel like navigating a maze. With its different parts, enrollment periods, and plan types, it’s easy to feel overwhelmed. Unfortunately, making a mistake during enrollment can lead to unexpected costs, coverage gaps, or limitations on seeing your preferred doctors.

By understanding a few common pitfalls, you can approach Medicare enrollment with confidence. Read on to discover five key Medicare enrollment mistakes to avoid ensuring you get the best healthcare coverage for you.

Mistake #1: Assuming Medicare is free

While you likely paid Medicare taxes throughout your working life, and some parts might not have a monthly premium, healthcare is not free.

• The Reality: Even with premium-free Part A, Part B (medical insurance) has a standard monthly premium (and potentially higher costs based on income). Both Original Medicare (Parts A & B) involve deductibles and coinsurance (typically 20% for Part B services after the deductible). Medicare Advantage (Part C) plans, even those with a $0 premium, have out-of-pocket costs like copayments and deductibles for services. Prescription Drug Plans (Part D) also have premiums and cost-sharing.
• How to Avoid It: Budget for healthcare costs beyond just premiums. When comparing plans (Original Medicare + Supplement vs. Medicare Advantage), carefully review the Summary of Benefits and Evidence of Coverage documents to understand deductibles, copays, coinsurance, and the plan’s maximum out-of-pocket limit. In addition, if you see advertisements referring to no-cost or $0 plans, please be hesitant; these should just be referring to $0 premiums, and that type of language is not compliant with current marketing regulations.

Mistake #2: Missing enrollment deadlines (and paying penalties)

Timing is crucial with Medicare. Missing your specific enrollment window without having other qualifying coverage can lead to lifelong penalties.

• The Reality: Your main enrollment window is your Initial Enrollment Period (IEP) – a 7-month period starting 3 months before your 65th birthday month, including your birthday month, and ending 3 months after. If you miss your IEP and don’t qualify for a Special Enrollment Period (SEP) (e.g., losing employer coverage), you might have to wait for the General Enrollment Period (GEP) (January 1 – March 31) and coverage won’t start until July 1st. Worse, you could face permanent late enrollment penalties added to your Part B and Part D premiums every month for as long as you have the coverage.
• How to Avoid It: Know your Initial Enrollment Period dates! If you plan to keep working past 65 with employer coverage, understand the rules around Special Enrollment Periods to enroll later without penalty. Mark deadlines on your calendar.

Mistake #3: Not checking provider networks for Medicare Advantage

Having insurance doesn’t guarantee your preferred doctor or hospital will accept it, especially with certain types of Medicare plans.

• The Reality: Original Medicare allows you to see virtually any doctor or hospital in the U.S. that accepts Medicare patients. However, Medicare Advantage (Part C) plans usually have specific networks (like HMOs or PPOs). Seeing providers outside the network can result in significantly higher costs or no coverage at all (except in emergencies).
• How to Avoid It: If considering a Medicare Advantage plan, always check the plan’s provider directory before enrolling. Confirm your essential doctors, specialists, and preferred hospitals are in-network. Don’t just assume – verify!

Mistake #4: Thinking you don’t need Medicare if you’re still working

If you’re working past 65 and have health insurance through your employer (or a spouse’s employer), you might think you can simply ignore Medicare. This isn’t always the best or correct approach.

• The Reality: Depending on the size of the employer, you might still need to enroll in Part A (it’s often premium-free). You might be able to delay Part B without penalty if the employer coverage is considered “creditable.” However, you should still compare the costs and benefits of your employer plan versus enrolling in Medicare (perhaps Parts A and B, or an Advantage plan). Sometimes Medicare can be primary or secondary insurance, or even a more affordable option.
• How to Avoid It: Don’t assume. Talk to your employer’s benefits administrator to understand how your insurance works with Medicare. Compare the premiums, deductibles, coverage details, and drug costs of your employer plan versus your Medicare options. Determine if your employer coverage is creditable for delaying Part B.

Mistake #5: Not understanding Original Medicare vs. Medicare Advantage

These are two fundamentally different ways to get your Medicare benefits, each with its own structure, costs, and rules. Choosing one without understanding the other can lead to dissatisfaction.

• The Reality:
  • Original Medicare: Run by the federal government (Parts A & B). Offers broad access to providers nationwide. Often paired with a separate Part D drug plan and potentially a Medigap (Medicare Supplement) policy to help cover cost-sharing.
  • Medicare Advantage (Part C): Plans offered by private insurance companies approved by Medicare. Must cover everything Original Medicare does. Often bundles Parts A, B, and D. May include extra benefits (dental, vision). Usually requires using a network of providers. Costs structured differently (e.g., copays).
• How to Avoid It: Assess your healthcare needs, budget, prescription drug usage, and travel habits. Do you prioritize provider choice (Original Medicare) or potentially lower premiums/extra benefits with network limitations (Medicare Advantage)? Research both options thoroughly. Remember that Medicare Advantage replaces Original Medicare; if you stay with Original Medicare, a Medigap plan supplements Original Medicare.

Choose wisely, enroll confidently

Medicare doesn’t have to be a source of stress. By being aware of these common mistakes – understanding costs, minding deadlines, checking networks, comparing options even while employed, and knowing the core differences between Original Medicare and Medicare Advantage – you can make informed choices.

Take your time, and do your research. Making the right Medicare decisions upfront can positively impact your health and financial well-being for years to come. Learn more in our Guide to Medicare Enrollment Periods.