Top 5 Medicare Mistakes To Avoid When Retiring in Philadelphia

Missing the Initial Enrollment Period (IEP) 

Your Initial Enrollment Period (IEP) is the first opportunity to enroll in Medicare for Philadelphia residents.

Missing this window can have significant consequences. 

The IEP Timeline: 

• Starts: Three months before your 65th birthday month 
• Includes: Your birthday month 
• Ends: Three months after your birthday month 

Enrolling during your IEP ensures your coverage starts on time and helps you avoid late enrollment penalties.  

These penalties can increase your Part B premiums by 10% for each 12-month period you were eligible but did not enroll. 

Steps to Avoid Missing the IEP: 

• Set Reminders: Use calendars, alarms, or reminder apps to keep track of your IEP. 
• Gather Information Early: Start researching Medicare plans six months before you turn 65. 
• Use Local Resources: Philadelphia offers resources and services to help you navigate the enrollment process, like us at CVIG! 
• Enroll Online: You can enroll in Medicare Part A and Part B through the Social Security Administration’s website. 

Underestimating the Costs of Medicare 

Medicare does not cover all healthcare costs, and it’s essential to understand what is and isn’t covered. 

What’s Covered by Original Medicare: 

• Part A: Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. 
• Part B: Certain doctors’ services, outpatient care, medical supplies, and preventive services. 

What’s Not Covered: 

• Prescription drugs (covered by Part D) 
• Dental, vision, and hearing services 
• Long-term care 
• Cosmetic surgery 
• Most chiropractic services 

How to Plan for Additional Costs: 

1. Consider Medigap: Medigap policies help pay some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. 
2. Look at Medicare Advantage Plans: These plans, offered by private companies, often include additional benefits like dental, vision, and hearing coverage. 
3. Budget for Out-of-Pocket Costs: Estimate your annual healthcare expenses and create a budget to cover these costs. 

Ignoring Medicare Part D 

Prescription drug coverage is an essential part of your healthcare plan in Philadelphia. Ignoring Part D can lead to high medication costs and penalties. 

Medicare Part D helps cover the cost of prescription drugs.

Not having this coverage can result in significant out-of-pocket expenses. 

Penalties for Late Enrollment

If you don’t enroll in a Medicare Part D plan when you’re first eligible, you may have to pay a late enrollment penalty.

This penalty is added to your monthly Part D premium and continues for as long as you have Medicare drug coverage. 

How to Choose a Part D Plan: 

• Review Drug Formularies: Check the list of covered drugs for each Part D plan available in Philadelphia. 
• Compare Costs: Look at the monthly premiums, deductibles, and copayments for each plan. 
• Check Pharmacy Networks: Ensure your preferred pharmacy is in the plan’s network. 
• Consider Your Medications: Choose a plan that covers your current medications and has a broad formulary for future needs. 

Overlooking Special Enrollment Periods (SEPs) 

Special Enrollment Periods (SEPs) allow you to enroll in Medicare without penalties if you have other health coverage when you turn 65. 

You qualify for a SEP if you or your spouse are still working and covered by a group health plan through an employer.

SEPs also apply if you lose this coverage. 

Benefits of SEPs

SEPs provide flexibility in enrolling in Medicare without facing late penalties.

This is especially important if you delay enrolling in Part B because you have other coverage. 

• Track Your Coverage: Keep detailed records of your health coverage and employment status. 
• Know the SEP Rules: Understand the conditions under which you can use a SEP. 
• Act Quickly: Once your employment coverage ends, enroll in Medicare during the SEP to avoid penalties. 

Not Reviewing Medicare Plans Annually 

Your healthcare needs and Medicare plans can change each year.

Failing to review your plan annually can mean missed opportunities for better coverage or cost savings. 

Annual Enrollment Period (AEP): From October 15 to December 7 each year, you can review and make changes to your Medicare plans. 

Why Annual Review is Important

Plans can change their coverage, costs, and provider networks. Your health needs may also change, requiring different coverage. 

Steps for Annual Review: 

• Compare Plans: Use the Medicare Plan Finder tool to compare available plans in Philadelphia. 
• Check for Changes: Look for any changes in your current plan’s coverage or costs. 
• Consider Your Health Needs: Assess your health needs and whether your current plan meets them. 
• Seek Help: Use local resources and counseling services to get assistance in reviewing and choosing plans. 

Conclusion 

Avoiding these common Medicare mistakes will help ensure your healthcare needs are met as you retire in Philadelphia.  

By understanding your Initial Enrollment Period, planning for additional costs, enrolling in Part D, leveraging Special Enrollment Periods, and reviewing your plans annually, you can make informed decisions.  

Take action early, seek local guidance, and empower yourself with the knowledge to make the most of your Medicare coverage in Philadelphia. 

By avoiding these mistakes, you can enjoy a smoother transition into retirement with the peace of mind that your healthcare needs are covered.