You pay into Medicare with every paycheck for decades, so you might think that signing up at 65 will be a simple process. But just glancing at the nearly 130-page “Medicare & You” official guide is a clue that it’s more involved than that.
There’s a range of options to wade through, and some decisions, such as when you enroll, can haunt you for a lifetime in penalties and higher premiums.
To find out what everyday folks have to say about Medicare, we recently asked Money Talks News readers what they wish they had known before they enrolled. Here’s what they told us.
A quick note about Medicare plans
There are two main types of Medicare coverage — Original Medicare (aka traditional Medicare) and Medicare Advantage.
Original Medicare plans are coverage you obtain directly from Medicare. They include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
If you opt for an Original Medicare plan and also want prescription drug coverage, known as Medicare Part D, you must buy such a plan separately. You also can buy a Medicare supplement insurance policy to help pay for expenses the Original Medicare plan doesn’t cover, like copays and deductibles. These supplemental policies are also known as Medigap plans.
Medicare Advantage plans are offered by private insurance companies, like HMOs and PPOs, that are approved by Medicare. Most plans include drug coverage.
Now let’s get into what our readers have to say about their Medicare plans and experiences.
1. Medicare is surprisingly complicated
Money Talks News readers describe a signup process full of fine print, deadlines and choices that were hard to compare, even for those who did their research and were somewhat familiar with the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the program.
Those with Original Medicare, a Medigap supplement and a drug plan tell Money Talks News that the program and enrollment are more complex than they were prepared for.
- “You must do your research prior to signing up for Medicare. There are some very sneaky and convoluted requirements and exceptions that will make a tremendous impact on your coverage. No-one is giving out the complete and coherent information.” — Mike C.
- “Why is CMS making Medicare so complicated? I researched a lot. Medicare options are complex. Most elderly [do] not understand.” — Jacob G.
- “The Medigap plans are too complicated to compare. If Plan F is supposed to be the same no matter which insurance company offers it, why do the prices vary so much? Most people will need help explaining the plans and the process to them. We’re college educated and we find it very confusing.” — Sam T.
- “[T]here are lots of supplemental companies for Medigap. I would have shopped around.” — Charlene J.
- “How very complicated it is to get things done correctly … to be better prepared to get the best coverage with less time wasted and stress. Learn everything first, well in advance, before signing up. Be knowledgeable in decisions made.” — Aileen S.
Readers on other plans express the same frustration:
- “It was Covid but when I researched it was hard to make a decision because the information seemed obtuse and I am an avid reader.” — Kim L. says of her Medicare Advantage plan.
- “Hard to get hold of, sometimes hard for patient to know if/what [Medicare] is doing after a request,” Arlene S. tells us. She also says the program ultimately does things right. She has Original Medicare and drug coverage through a secondary Federal Employees Health Benefits plan.
Getting the feeling you need to do more research? Start with “7 Facts You Need to Know About Medicare.”
2. Medicare is vulnerable
Some readers worry more about the stability of their Medicare benefits after discovering how exposed the program can feel to budget cuts and policy changes.
Here’s what readers report:
- “With the current administration, I’m very worried about changes to our Medicare coverage. It’s great coverage now, but they’re already looking at ways to slash benefits.” — Melody D.
- “That Original [Medicare] may start requiring precertifications. If [that] occurs I see little benefit to keeping my plans with high premiums.” — Karen A.
- “I wish that I had realized what a collection of poltroons and thieves were running this system.” — Mike C.
- “I wish I had known that our government could threaten our health coverage. At 83, how long will I have coverage?” — Carole D.
Read Money Talks News founder Stacy Johnson’s take on Medicare’s well-being in “It’s Not Just Social Security: Medicare’s Squeeze Starts in 2033.”
3. Medicare is more expensive than expected
A lot of people assume Medicare is free once they turn 65. It isn’t, and the bills surprise readers across every type of plan.
Here’s what readers with Original Medicare, plus supplemental and drug coverage have to say:
- Melody D. wishes she’d known “how much and how fast all the premiums could go up in cost … so I could have planned to work longer! And I’m already 68 and still full-time employed!”
- Kathleen P. notes “how expensive it is,” and if she’d known that sooner, she would have tried to save more.
- Diane M. says, “It’s a rip off; work hard all of your life for this?”
- Patricia O. is surprised by “the expense of all parts together,” and says that it’s “just making life as a senior harder.”
- Garland G. has plans to drop Part D due to how expensive it is: “I pay more for Part D coverage than I do for medications in the pharmacy.”
- For Joan A., the “premium is too high.”
Medicare Advantage plans have surprise costs too, according to our readers:
- Sheri F. wishes she’d known how much her Medicare Advantage plan would cost, so that she could have avoided an “unpleasant surprise.”
- “I wish I would’ve known how much it cost and that cost-of-living raises barely cover the increase every year for Medicare.” — Gna J.
- “Medicare has copays and deductibles.” — Eileen E.
- “Its not free.” — Steve O.
- “Not having to pay Part B … out of deflated (Social Security).” — Lois A.
If you think Original Medicare might spare you some expense, find out what these readers have to say about that:
- “The cost is EXPENSIVE! Why have I paid into Medicare and still pay even MORE once I start using it?” — Herbert C.
- Joan M. notes “how expensive B costs. Co pays are higher than expected. Co pays for ER visits keep going up. If sent to ER by your doctor but not admitted to hospital should be covered by Medicare A.”
- Cheryl C. says that she “had no idea it was going to cost me anything! It was a shock! It costs me about $600 – $700 per quarter.” Even so, she’s grateful for the program.
4. Medicare doesn’t cover everything
Medicare covers a lot, but it does not cover some of the benefits people most expect from health insurance, like vision, dental and hearing.
Jorge L. has Original Medicare, a Medigap supplement and a drug plan and wishes he’d known that vision isn’t covered under his plans. “I need eyewear,” he explains. Anjanette W. has the same coverage and writes that she “would have planned better” to cover the “high cost of drugs, no vision or eye coverage. Too many loop holes.”
It may seem like Medicare Advantage plans cover more, but that’s not always the case. Karen R. wishes she’d better understood and better planned for “all the things it does not cover.”
Yvonne J. also has Medicare Advantage and tells Money Talks News, “I wish I had known Medicare needs to cover anti-stress preventative measures and doesn’t. I would have looked for other options. Most diseases are stress-related and we need more help with it.”
And Jill B., covered by both Medicare and Medicaid, says of dental care: “They don’t cover very much dental work … Because no sooner than I turned 65 and the pandemic was underway that I started tooth clenching!”
5. Not all doctors accept it
Another difficulty of Medicare is finding a doctor who will take it. Many readers assumed their coverage would be welcome anywhere and were surprised to find out otherwise.
Janie S., who has Original Medicare, a Medigap supplement and drug plan, says she didn’t know that “numerous practitioners refuse to accept Medicare,” or “that doctors I’ve seen for years could refuse treatment (or require that I pay out of pocket) once I began using Medicare.”
Kathy M., on Original Medicare only, wishes she’d known “how to get a physician. I moved to a new city and had a very difficult time establishing medical care.”
Diane O. has Medicare Advantage and wishes she knew beforehand how hard it would be to find a plan that her existing providers would accept. “I would’ve started comparing plans much earlier,” she said.
6. Your income can make your premiums higher
Many folks are unfamiliar with IRMAA (income-related monthly adjustment amount). It’s an extra charge added to Part B and Part D premiums for people above certain income levels, and it looks back at your tax return from two years earlier.
Three of our survey participants who have Original Medicare, a Medigap supplement and drug coverage were hit with higher premiums due to IRMAA.
Denise T. didn’t know “that the Part B premium was based on salary two years earlier,” and if she had, she “wouldn’t have been shocked by the IRMAA payment.”
Mary V. says that if she’d known about IRMAA, she “might have waited to apply for Medicare.”
Debe Z. notes that being informed ahead of time would have helped her “plan for cost.”
Learn more in “8 Types of Income That Can Jack up Your Medicare Premiums.”
Read the full article here
