Category Archives: Health insurance

Top 10 Costly Medicare Mistakes to Avoid 

Medicare can provide excellent healthcare coverage—but only if you navigate it correctly. Each year, many beneficiaries end up paying more than necessary or facing coverage gaps simply because of avoidable mistakes. Understanding these common pitfalls can help you make smarter decisions and protect both your health and your wallet.

Here are the top 10 Medicare mistakes to avoid :

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1. Missing Your Enrollment Window

One of the most costly mistakes is not enrolling in Medicare on time. Your Initial Enrollment Period (IEP) begins three months before your 65th birthday and ends three months after.

Why it matters:
Missing this window can result in lifelong late enrollment penalties for Part B and Part D—and delays in coverage.

When You Can Delay Medicare:

If you’re still working at age 65 and have credible employer-sponsored health insurance, you may delay Medicare:

✔️ You can usually delay:

• Part B (medical insurance)
• Part D (drug coverage) (if your employer plan is considered “creditable”)

✔️ You may also delay Part A:

• Most people get Part A premium-free, so many enroll anyway
• However, if you contribute to an HSA, delaying Part A is often recommended (since Medicare enrollment stops HSA contributions)

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The Key Factor: Employer Size

🟢 Employer has 20+ employees

• Your employer coverage is primary
• Medicare is secondary
• ✅ You can safely delay Part B and Part D
• ❗ No late penalties if you enroll later

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🔴 Employer has fewer than 20 employees

• Medicare becomes primary
• Employer coverage is secondary
• ❗ You generally need to enroll in Medicare at 65
• ⚠️ Delaying could leave you with little or no coverage and possible penalties

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Special Enrollment Period (SEP)

If you delay Medicare due to employer coverage, you’ll get a Special Enrollment Period when that coverage ends:

• 8 months to enroll in Part B
• 63 days to enroll in Part D

This allows you to sign up without penalties.

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Common Mistakes to Avoid

• Assuming all employer coverage allows delay (it must be creditable)
• Not confirming employer size rules
• Missing the Special Enrollment window after retiring
• Automatically enrolling in Part A while contributing to an HSA

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Quick Example

• If you’re 67 and working at a large company with good insurance → you can delay Medicare
• If you’re 65 and working at a small business → you likely need Medicare to avoid gaps

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Bottom Line

You can delay Medicare with employer coverage—but only if:

• Your employer has 20+ employees, and
• Your coverage is considered creditable

Otherwise, delaying could cost you in penalties or uncovered medical bills.

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2. Assuming Medicare Covers Everything

Medicare provides broad coverage, but it doesn’t cover everything.

Common gaps include:

• Dental care
• Vision exams and glasses
• Hearing aids
• Long-term care

What to do instead: Consider supplemental coverage like Medigap or a Medicare Advantage plan that includes extra benefits.

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3. Not Comparing Plans Each Year

Many people stick with the same plan year after year—but plans change annually.

What can change:

• Premiums
• Drug formularies
• Provider networks

Tip: Review your options during Open Enrollment (October 15–December 7) every year.

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4. Ignoring Prescription Drug Coverage (Part D)

Even if you don’t take medications now, skipping Part D can be a costly mistake.

Why it matters:
You may face a permanent late enrollment penalty if you sign up later—and unexpected drug costs if your health changes.

What Triggers the Part D Penalty?

You’ll face a penalty if both of these are true:

• You didn’t enroll in a Medicare Part D plan when you were first eligible
• You went 63 days or more without creditable prescription drug coverage

Creditable coverage usually means:

• Employer or union drug coverage that’s at least as good as Medicare
• VA or other qualifying coverage

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How the Penalty Is Calculated

The penalty is not a one-time fee—it’s a monthly charge for life.

Formula:

1% × national base beneficiary premium × number of months you went without coverage

For 2026:

• Base premium ≈ $38.99
• 1% = about $0.39 per month per uncovered month

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Example

Let’s say you delayed Part D for 24 months without creditable coverage:

• 1% × $38.99 = $0.39
• $0.39 × 24 months = $9.36/month penalty

That gets added to your Part D premium every month—for life.

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Important Details

• The penalty is rounded to the nearest $0.10
• It can increase over time as the base premium changes each year
• You pay it as long as you have Part D
• It applies even if you later switch plans

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When You Won’t Pay a Penalty

You can avoid the penalty if you:

• Enroll in Part D when first eligible
• Have creditable drug coverage (like from an employer)
• Qualify for Extra Help (Low-Income Subsidy)

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Common Mistake

A lot of people think:
“I don’t take medications, so I don’t need Part D.”

That’s exactly how the penalty happens.

Even if you don’t need prescriptions now, enrolling in a low-cost plan protects you from lifelong penalties later.

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Bottom Line

• The Part D penalty = small monthly charge that adds up forever
• It’s based on how long you go without coverage
• The easiest way to avoid it: don’t go more than 63 days without creditable drug coverage after becoming eligible

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5. Choosing the Wrong Path: Original Medicare vs. Medicare Advantage

Many beneficiaries don’t fully understand the trade-offs between these two options.

• Original Medicare: More provider flexibility, but higher out-of-pocket costs without supplemental coverage
• Medicare Advantage: Lower premiums, but network restrictions and plan rules

Mistake: Choosing based only on premiums without considering total costs and access.

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6. Not Budgeting for Out-of-Pocket Costs

Even with Medicare, you’ll still pay deductibles, copays, and coinsurance.

Reality check:

• Part B typically covers only 80% of services
• Hospital stays can come with significant deductibles

Solution: Plan ahead or consider Medigap to reduce unexpected expenses.

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7. Overlooking Medigap Enrollment Timing

Medigap (Medicare Supplement Insurance) is easiest to get when you first enroll in Medicare.

Why timing matters:
During your Medigap Open Enrollment Period, you can’t be denied coverage or charged more due to pre-existing conditions.

Miss this window, and you may face underwriting

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8. Not Checking Doctor Networks

If you choose a Medicare Advantage plan, not all doctors may be in-network.

Mistake: Assuming your current doctors are covered.

Fix: Always verify your providers and preferred hospitals before enrolling.

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9. Failing to Understand IRMAA (Income-Related Costs)

Higher-income beneficiaries pay more for Part B and Part D.

Mistake: Being surprised by higher premiums.

Tip: If your income has recently dropped (e.g., retirement), you can appeal your IRMAA determination.

2026 IRMAA Chart (Income-Related Monthly Adjustment Amount)
Based on your 2024 tax return (filed in 2025)

IRMAA increases your Medicare Part B and Part D premiums if your income is above certain thresholds. Here’s a clean, easy-to-read breakdown for 2026:

Medicare Part B IRMAA – 2026

Individual Filers

Income (MAGI)	Total Monthly Premium
≤ $106,000	$202.90
$106,001 – $133,000	$284.00
$133,001 – $167,000	$405.00
$167,001 – $200,000	$527.00
$200,001 – $500,000	$560.50
> $500,000	$608.90

Married Filing Jointly

Income (MAGI)	Total Monthly Premium (per person)
≤ $212,000	$202.90
$212,001 – $266,000	$284.00
$266,001 – $334,000	$405.00
$334,001 – $400,000	$527.00
$400,001 – $750,000	$560.50
> $750,000	$608.90

Medicare Part D IRMAA – 2026

(Added on top of your plan premium)

Individual Filers

Income (MAGI)	Monthly IRMAA
≤ $106,000	$0
$106,001 – $133,000	$14.50
$133,001 – $167,000	$37.50
$167,001 – $200,000	$59.90
$200,001 – $500,000	$82.20
> $500,000	$91.00

Married Filing Jointly

Income (MAGI)	Monthly IRMAA
≤ $212,000	$0
$212,001 – $266,000	$14.50
$266,001 – $334,000	$37.50
$334,001 – $400,000	$59.90
$400,001 – $750,000	$82.20
> $750,000	$91.00

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10. Getting Advice from Unreliable Sources

Medicare decisions are complex, and misinformation is common.

Mistake: Relying on outdated or biased advice.

Better approach:

• Use official Medicare resources
• Work with licensed advisors
• Compare multiple plan options

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Final Thoughts

Avoiding these common Medicare mistakes can save you thousands of dollars and prevent unnecessary stress. Medicare isn’t “set it and forget it”—it requires ongoing attention, especially as your health needs and plan options evolve.

The key takeaway: be proactive, review your coverage annually, and don’t assume your current plan is still your best option.

A little effort each year can go a long way toward ensuring you have the right coverage at the right cost.

How Life and Med Can Help

Healthcare policy is more confusing than ever — but you don’t have to navigate it alone. At Life and Med, we specialize in helping individuals and families make sense of their healthcare options, especially during times of change.

Patricia Saint Louis, RN–Health Insurance Broker offers expert guidance in:

• Reviewing and comparing Medicare Advantage and Supplement Plan
• Identifying eligibility for Medicare Savings Programs or Extra Help
• Helping you respond to policy changes and stay covered

📍 Office: 216 N 3rd St, Suite B, Leesburg, FL
📞 Phone: 352-260-0202

Don’t wait until your coverage is at risk — contact us today and let’s make sure you’re protected, informed, and empowered.

 

Did you know that more than 100 million Americans are obese, and more than 22 million Americans are severely obese. Being obese is expensive, as Obese people spend nearly $2,000 more in annual medical costs than people who are considered to be of a healthy weight, and people who are severely obese spend about $3,000 more than people who are deemed to be of a healthy weight. People are obese for many different reasons, whether it be conditions like diabetes, unhealthy eating habits, etc., and one way that we see people curb this issue is with the use of weight loss drugs like Ozempic. 

 

Knowing these facts on obesity, those who are obese or severely obese must understand their insurance coverage due to some of these financial setbacks caused by obesity and the heavy costs of some of these weight loss drugs. A big question that may come up for seniors who are obese or severely obese is whether or not Medicare will cover these weight-loss drugs for them. 

 

The key component in understanding whether or not Medicare will cover these drugs is understanding the different parts of Medicare, alongside which plan you have. Below is a quick summary of the parts of Medicare

 

• Part A: Medicare Part A, also known as hospital insurance, primarily covers inpatient care. This includes stays in a hospital where you are formally admitted, care in a skilled nursing facility following a qualifying hospital stay, hospice care for individuals with a terminal illness, and some limited home health care services. It is intended to help with services related to serious health events that require a stay in a medical facility or specialized end-of-life care.
• Part B: Medicare Part B covers outpatient medical services and preventive care. It includes doctor visits, outpatient procedures, lab work, diagnostic tests, imaging services like X-rays or MRIs, and certain types of home health care. Preventive services such as flu shots, annual wellness visits, and screenings for conditions like cancer and diabetes are also included. In addition, Part B provides coverage for mental health services, durable medical equipment (like walkers or wheelchairs), and ambulance transportation when medically necessary.
• Part C: Medicare Part C, commonly referred to as Medicare Advantage, is an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare. While they are required to provide at least the same coverage as Original Medicare, many Medicare Advantage plans include additional benefits not typically covered, such as prescription drugs, dental, vision, hearing, wellness programs, and gym memberships. These plans often use network-based models like HMOs or PPOs, which means members may need to use providers within the plan’s network.
• Part D: Medicare Part D provides coverage for prescription drugs. This part of Medicare is also offered through private insurance companies and helps to cover the cost of medications prescribed by a healthcare provider. Each Part D plan has a formulary, or list of covered drugs, which is organized in tiers that determine how much you pay for each medication. Coverage typically includes drugs for common conditions such as high blood pressure, diabetes, and high cholesterol, along with certain vaccines and specialty medications. Plans also include rules like prior authorization or step therapy for specific drugs.

 

Now that we know all the different parts of Medicare, it is important to understand that although weight loss surgery and behavior counseling would fall under Parts A and B, weight loss drugs wouldn’t, however, they could fall under Parts C and D. Knowing all of this is important as well so you can make the right decision when it comes to choosing your Medicare Plan. 

 

The question now is, will Parts C and D cover your weight loss drugs, and the answer is maybe. Medicare covers FDA-approved medications for those with diabetes, heart conditions, or other conditions affecting weight gain. These include Mounjaro, Ozempic, Rybelsus, Victoza, and Trulicity, which are good for those who qualify. Some notable drugs not covered include Saxenda, Wegovy, and Zepbound. Any drug prescribed only for obesity or weight loss is excluded from Medicare coverage under current law. This puts those who aren’t diabetic, as well as weight loss drugs that are classified as cosmetic, in a tough spot. 

 

While for some learning that they won’t be able to use Medicare to cover purchase of weight loss drugs may be a massive letdown, hopefully there can be some comfort taken in some alternatives that may be covered by Medicare, like weight loss surgery, behavioral counseling for obesity, diabetes management programs, and nutrition programs.

 

Another option for those struggling with the costs of weight loss drugs is the many different drug discount programs, like AARP, GoodRx,  and WellRx. Seniors can also look into different drug manufacturer coupons to help them curb costs.

 

Ultimately, if and when you have questions, it is always best to look at your drug plan to see what benefits you have associated with your plan. If you have further questions, it is recommended that you speak to a doctor or a trusted Medicare advisor, such as Patricia Saint Louis, at 352-260-0202