The 10 most important things to know about Medicare

6. You should re-shop your coverage.  The annual enrollment period for Part D and Advantage programs runs from October 15 to December 7 each year. This is the opportunity for seniors already signed up for Medicare to re-shop their coverage – and you should do it annually. Insurance companies often change their offerings year-to-year in ways that can increase drug costs by thousands of dollars, or make it more difficult to get certain drugs. At the same time, your drug needs may have changed since the last plan selection period in ways that make a plan less beneficial for you. Check my guides to shopping prescription drug and Advantage plans for more details.

7. The Affordable Care Act improved Medicare. The Affordable Care Act (ACA) isn’t primarily focused on Medicare. But despite what you’ve heard, the law improves Medicare, rather than harm it. The law shrinks the prescription drug program’s catastrophic-level coverage gap – known as the “donut hole” – and added a free annual preventative check-up. For retirees not yet 65 years old, the new insurance exchanges provides an important new guarantee that insurance coverage will be accessible – the law prohibits insurers from turning away applicants with pre-existing conditions. Insurers also can’t put lifetime limits on the dollar value of coverage or rescind coverage if you become ill.

8. Don’t confuse Medicare and the ACA. Annual enrollment for Medicare and ACA marketplace exchanges overlap. Medicare prescription drug (Part D) and Advantage (Part C) enrollment runs from Oct. 15 to Dec. 7 each year; shopping for ACA exchange policies run from Nov. 15 to Feb. 15. Consumer assistance groups report that some Medicare enrollees mistakenly think they must also enroll in the ACA exchanges (they do not). And for people with ACA plans who are turning 65, the transition to Medicare can be tricky. Here’s my rundown of key red flag issues for seniors.

9. Long-term care isn’t covered (much). Medicare does cover the first 100 days of care in skilled nursing facilities for patients who were first formally admitted to a hospital for three consecutive days. It also covers some home health services and hospice care. But Medicare doesn’t cover ongoing nursing home or assisted living charges. This page at the Medicare website details what is covered.

10. Costs are accelerating. Medicare program costs (and premiums) moderated quite a bit during the recession, but are on an upward trajectory again. The Part B premium stayed at $104.90 for 2016 for most beneficiaries due to the way that  Part B premium is calibrated with Social Security’s cost-of-living adjustment (COLA). Their Part B premium can’t be increased beyond a point that would yield a net reduction in Social Security benefits—the so-called “hold harmless” rule. But For those not held harmless,monthly premiums rose to $120.70, plus a $3 surcharge. All indications are that there will be upward pressure on premiums for the foreseeable future.


Pages: 1 2


  1. Donna Kaniss says:

    There are a couple of points that I think are very important that I never see mentioned in articles about Medicare. These items are so not mentioned that I wonder if I have a correct understanding about them. I would appreciate if you would clarify on these issues:
    Is it true that:
    1) Once you have signed up for a Medicare Advantage program and stayed on that program for an entire year, you are no longer eligible to switch back to a regular Medicare Part B policy where you can choose your own physicians, etc., unless there is some special circumstance such as your plan going out of business or you move to an area your Advantage plan doesn’t cover, etc.;
    2) Once you have signed up with an insurance provider for MediGap coverage, if you later wish to change insurance providers you would need to undergo medical underwriting which can make the plan with the new provider more expensive than if you had signed up with that new provider iniitially – or they could deny you coverage entirely due to pre-existing conditions, etc.
    Thank you.

  2. Mark Miller says:

    Donna, good questions…..

    1) Using Medicare Advantage does not prevent you from going back to traditional Medicare. But usually, you would have to wait for the annual enrollment period to make that switch.

    2) One benefit of signing up for Medigap when you initially enroll in Medicare is that there is no medical underwriting at that time. Under national law, you have a six-month open enrollment period that begins the month you turn 65 to buy a policy with no underwriting. Beyond that, there are all kinds of wrinkles and rules. Here are links to two posts that may help you with this:

  3. Donna Kaniss says:

    Thank you, Mark. That is very helpful. I think the reason I got confused about whether you can go back to traditional Medicare after having a Medicare Advantage plan for more than a year is the point that is made about the protected period for purchasing a MediGap policy :

    From the first article you mentioned, “ :

    “If you joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months, you have the right to buy any Medigap policy offered in your state by any insurance company.” — so if after 12 months you decide to switch back to traditional Medicare, you may not be able to purchase a MediGap policy or you may have to pay a higher price for it or have to wait for pre-existing conditions to be covered if they are covered at all. I know I would have trouble covering all the expense gaps in traditional Medicare without Medigap coverage so I know I would be unable to switch back after a year on a Medicare Advantage plan.
    It is all very confusing and I appreciate that you have taken the time to gather and share all this information.

  4. I have read several articles that say you do not need medigap insurance if you enroll in a medicare advantage program. And it is against the law if a company tries to sell you medigap insurance with an advantage program. Please tell me if this is true and clarify if needed. Also are there any online courses that cover becoming a medicare specialist? I have seen articles saying go to college for medical billing and coding. This is not what I am looking for. I am just interested in knowing everything i can about the medicare programs and how to choose. As the oldest child on both my mom and dads side choosing the medicare insurance is left to me and I have read everything I can but I know there are still a lot of things that have been left out. I would like to know more.

  5. Mark Miller says:

    Tiffany, that’s correct – Medigap is not needed with Medicare Advantage, and insurance companies are not permitted to sell it to M.A. enrollees. Sorry to report I am now knowledgable about Medicare education, but perhaps other readers can offer thoughts.

  6. Bruce King says:

    Mark, How do I quantify waiting for SS until 66 vs suffering Medicare price inflation?

  7. Mark Miller says:

    Bruce, good question. I will look into this a bit, but drop me a note here if you like with more detail about your situation: in particular, your Primary Insurance Amount listed on your SS statement, current age and also age/PIA of your spouse, if any.

  8. Don Lewis says:

    when I started receiving Medicare in 2013 my cost for part B was $104.90 But in 2014 and 2015 I earned above the threshold and my medicare payments went up to $170.50 and $187 50 on 2016 and 2017. Last year my income fell back below the threshold, so in 2018 will I pay the original 104.90 under held harmless, or will it increase to $120.70 plus $3 without held harmless protection.

Speak Your Mind