5 Mistakes to Avoid when Enrolling in Medicare Advantage

Those of you how thought it would never come, it has: You’re turning 65 and you need to enroll in Medicare. What now?

By Diane Omdahl, RN, MS, co-founder of 65Incorporated.com

Those of you how thought it would never come, it has: You’re turning 65 and you need to enroll in Medicare. If you’re healthy, perhaps you’re thinking a Medicare Advantage plan makes the most sense to enroll in.

But before you sign on the dotted line on a given plan, realize this choice is more important to make than which television show you’re going to watch on Monday, or the sandwich you’ll be ordering at the deli. Indeed, dodging any Medicare Advantage pitfalls before you enroll will save you time, money and frustration.

Specifically, here are five mistakes to avoid when picking a Medicare Advantage plan with prescription drug coverage, as well as tips for how to avoid them.

1. Judging plans by the premium only. 

Note other out-of-pocket expenses, such as the deductible, coinsurance, and copayments for services you will use. Here’s an example that might help you envision your own situation:

George suspects he will need a knee replacement in the near future. He must check out the services he will use. A zero-premium plan has a maximum copayment for outpatient therapy of $225 per visit. A plan with a monthly premium of $25 charges a maximum of $45 per visit.

2. Paying for coverage in the drug plan donut hole you may not need. 

This extra coverage runs about $30 to $60 more per month (in most cases) for coverage of medications in the donut hole. Only one-in-five drug plan members ends up in the so-called Coverage Gap. 

3. Picking a plan with the lowest medication deductible. 

On average, those who do this overspend by more than $250. That’s money they could use on the grandchildren or spend toward a vacation!

4. Ignoring the quality ratings.

Every plan has a star rating, a measure of the plan’s quality and an indication of how it will be to work with that plan. Learn more about Medicare’s quality ratings at www.medicare.gov/Pubs/pdf/11226.pdf.

5. Not doing your homework.

You decide to purchase the same plan that works for your best friend. Or, you take your agent’s advice without checking other options. Take the time to enter all your prescribed medications into the Medicare Plans Finder (at medicare.gov) and dig into the details about coverage and costs. It will be time well spent, trust me.


Diane J. Omdahl, RN, MS, is co-founder of Mequon-based 65 Incorporated, a Medicare resource providing unbiased information to the aging population through comprehensive multimedia products. A pioneer in home health agency management and training, Diane has kept her finger on the pulse of the healthcare industry’s evolution for more than 30 years and is known for authoring one of the most resourceful guides to the Medicare process for homecare agencies, the Beacon Guide to Medicare Service Delivery.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Melinda Caughill February 27, 2013 at 10:44 PM
Diane is a nationally known Medicare expert and is located in our backyard! Lucky us.
Cathy Ott March 03, 2013 at 03:57 AM
Congratulations on your continued success!


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