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Common Medicare Beneficiary Mistakes

Medicare can be confusing, especially with its many rules and enrollment periods. Unfortunately, even small mistakes can lead to coverage gaps or lifetime penalties. Here are some of the most common Medicare beneficiary mistakes and missteps to avoid.

Missing Your Initial Enrollment Period

Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It starts three months before your 65th birthday, includes your birthday month, and ends three months after. Waiting too long to sign up can delay your coverage and lead to permanent late enrollment penalties — especially if you don’t have other creditable insurance.

Watch a YouTube video on Medicare enrollment periods

Assuming COBRA or Retiree Coverage Lets You Delay Medicare

If you have COBRA or retiree insurance, don’t assume it allows you to postpone Medicare. COBRA is not creditable coverage for delaying Part B or Part D. Failing to enroll when first eligible can leave you uninsured and subject to lifetime penalties once you do sign up.

Not Enrolling While Working for a Small Employer

If you’re still working and your company has 20 or fewer employees, Medicare becomes your primary insurance, not your employer plan. Failing to enroll in Medicare on time could mean denied claims and unexpected bills.

Ignoring the Need for a Part D Drug Plan

Even if you don’t take prescriptions, you should enroll in a Part D plan when first eligible. Without it, you’ll face a permanent late enrollment penalty once you do sign up, and you’ll have to wait until the next enrollment period for your coverage to start. Many beneficiaries choose an inexpensive plan simply to avoid future penalties.

Confusing Medigap Enrollment Rules

Unlike Medicare Advantage or Part D, Medigap doesn’t have an annual election period. Your one-time Medigap Open Enrollment Period begins when you enroll in Part B. During these six months, you can get a Medigap plan with no health questions — miss it, and medical underwriting could apply later.

Paying the Part B Deductible Too Soon

Some providers mistakenly request the Part B deductible before Medicare processes your claim. Always wait until Medicare applies the deductible to the correct bill to avoid confusion or overpayment.

Bottom Line

Understanding Medicare’s timelines and coverage rules can save you from penalties, gaps and unnecessary stress. Taking the time to review coverage options and asking your agent questions before you enroll helps you get the most out of your benefits.

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Unfortunately, as people age, the risk for chronic conditions like heart disease, diabetes, and cancer increases. Although with the right preventive measures in place, many of these conditions can be delayed, managed effectively, or even avoided. That is why we will go over the importance of preventative services for Medicare beneficiaries.

Preventive Healthcare

The objective of Preventive healthcare is to maintain wellness and discover health issues before they become serious. It includes regular checkups, screenings, immunizations, counseling, and lifestyle intervention. These services are all designed to detect potential health problems early or prevent them from happening.

Why Preventative Service for Medicare Beneficiaries Matters

Early Detection

Some serious conditions, such as colorectal cancer or high blood pressure, may not show symptoms until they’ve progressed. That is why routine screenings are important. They can catch these conidtions early, when they’re easier to treat. This helps the beneficiary have a better qualityof life and save money on treatments.

Managing Chronic Conditions

Due to the fact that, over two-thirds of Medicare beneficiaries suffer from multiple chronic conditions, preventative care is essential. Preventive care helps manage these illnesses more effectively, avoiding emergency visits, hospitalizations, and complications. Annual wellness visits give beneficiaries an opportunity to review medications, coordinate care, and update personalized prevention plans.

Immunizations

Keep in mind; Flu shots, shingles vaccines, and COVID-19 boosters can be life-saving for older adults whose immune systems may not be as strong as younger individuals. Medicare Part B covers many of these vaccines. Staying up-to-date with immunizations can help prevent avoidable illness and hospital stays.

Mental and Cognitive Health

Preventive care also includes screenings for depression and cognitive impairment that are critical as people age. These services allow early interventions that can improve quality of life and help individuals maintain independence.

Health Education and Lifestyle Support

Through programs like smoking cessation counseling and diabetes self-management training, Medicare supports healthier living. Lifestyle changes such as, eating healthier foods, excercising or quitting smoking can dramatically reduce the risk of future health problems.

Overcoming Barriers to Access

Despite the clear benefits, many beneficiaries don’t fully utilize preventive services. Reasons include lack of awareness, confusion about coverage, transportation challenges, or simply not knowing what’s available to them. That’s why education and outreach; especially from healthcare providers, caregivers, and community organization are so crucial.

In the event a client wants to have better coverage for an illness, agents should understand the benefitof ancillary products to avoid gaps in coverage.

Agents: Watch a quick YouTube video on why and how to sell ancillary products

Preventive healthcare isn’t just about avoiding illness. It’s about living better, longer, and keeping your independence. For Medicare beneficiaries, taking advantage of all the preventive services Mediare covers is one of the smartest health decisions they can make.

Many Medicare beneficiaries will receive new Medicare cards. This is due to a breach of PII (personally identifiable information) as well as some personal health information. CMS (Centers for Medicare & Medicaid Services) and WPS (Wisconsin Physicians Service Insurance Corporation) are sending out notifications to individuals who’s information may be at risk.

This incident occurred in connection with WPS and the Medicare administrative services they provided for CMS. WPS is a contractor that CMS hired to handle Medicare Part A and B claims and related services. Apparently a specific software application WPS used to transfer files showed a potential risk. This may have caused personal information of Medicare beneficiaries as well as other individuals who use the same providers to be as risk.

What personal information is at risk

Some information that may be at risk due to the incident are:

1. Name
2. Date of birth
3. Social Security number or taxpayer ID
4. Medicare Beneficiary Identifier (MBI)
5. Mailing address
6. Hospital/provider account numbers
7. Health insurance claim number
8. Date of service

Who is receiving the notices

Both CMS and WPS are sending written notices to the 946,801 Medicare beneficiaries who may be affected. The notice lets them know about the breach as well as what they are doing in response.

Additionally; CMS is posting a notice for those who may not receive the written notice due to lack of correct contact information. See below for a sample of the letter WPS is sending:

Dear_______________:

The Centers for Medicare & Medicaid Services (CMS), the federal agency that manages the Medicare program, and Wisconsin Physicians Service Insurance Corporation (WPS), are writing to inform you of an incident involving your personal information related to services provided by WPS. WPS is a CMS contractor that handles certain Medicare claims in your state.

The incident involved a security vulnerability in the MOVEit software, a third-party application used by WPS for the transfer of files during the Medicare claims process. WPS is among the many organizations in the United States that have been impacted by the MOVEit vulnerability.

We are sending you this letter so that you can understand more about this incident, how we are addressing it, and additional steps you can take to further protect your privacy. We are providing information on free credit monitoring with this notice, and we will be giving you a new Medicare card with a new Medicare Number.

Your current Medicare benefits or coverage are not affected as a result of this incident.

What CMS is doing about this

CMS and WPS are working together along with law enforcement agencies and cybersecurity forensic consultants to investigate the incident. CMS is taking all actions necessary to protect the personal information of Medicare beneficiaries.

What Medicare beneficiaries can do

WPS is providing those effected with a free Experian 12 month credit monitoring service. It is a good idea to take advantage of this. Beneficiaries do not provide any form of payment information to enroll in this service.

It is important to take advantage of free credit reporting services. Everyone is entitled to a free report every 12 months from the three major credit reporting agencies:

Request a copy of your credit report: 

Visit the Experian website or call (888) 397-3742

Call TransUnion at (800) 916-8800 

Visit the Equifax website or call (888) 378-4329 

Beneficiaries can also call 1-877-322-8228 or request your free credit reports online at annualcreditreport.com.  Once you receive the report, check for issues or inquiries for new accounts you did not request.

Monitoring credit is a way to detect problems early and address issues quickly. Contact law enforcement about suspicious activity and get a copy of any reports filed to send to creditors as proof. Beneficiaries can also file a report with the FTC either on their website by phone 1-877-idtheft (1-877-438-4338) or by mail Federal Trade Commission, Consumer Response Center, 600 Pennsylvania Ave, NW, Washington, DC 20580.

Medicare Cards

Beneficiaries will continue to use their existing Medicare card. CMS is sending new cards with new MBIs for those who may affected. Once the beneficiary receives the new card, they should follow the instructions that come with the card. The instructions will include when to start using the new card. Beneficiaries should destroy their old card at that time. It is important that they give the new number to their providers to avoid delays in payments.

Learn why using a Medicare agent can be a great idea.   

More Information

Beneficiaries who have questions about this can call the confidential toll-free Experian response line at 833-931-5700. Just provide engagement number B130492, there are professionals familiar with this incident and can advise how to protect yourself from information misuse. Reach the professionals at the response line Monday -Friday 8 am – 8 pm Central Time (excluding major U.S. holidays).