JUST PLAIN TALK: What to know before Medicare enrollment

Buz Livingston
Buz Livingston

“When I’m 64” was one of the first songs Sir Paul McCartney wrote. When I first heard “Sergeant Peppers,” little did I realize 64 would get here so quickly, and I would be ecstatic. Next year, Medicare enrollment will not be a theoretical exercise; I will be three months shy of 65 and ready to sign up.

Medicare has strict, intricate and potentially burdensome deadlines for enrollment. Enrollees have from the three months before age 65 to three months afterward. However, if they are on COBRA, the period extends to eight months afterward. Missing the deadline carries a 10% lifetime penalty for every 12 months delayed, ouch.

During sign up, Oct 15 through Dec. 7, enrollees can switch between Part D drug plans, move from Medicare Advantage (Part C) to Traditional Medicare, or choose a different Medicare Advantage Plan. Less than 15% of beneficiaries change Part D plans, but the ones who change see premiums drop at least 5%. Part C can cost less, but you must use a healthcare maintenance organization (HMO) in your network or pay more for out-of-network providers.

Medigap supplemental policies are “guaranteed issue” or no restrictions on pre-existing conditions within 63 days of transitioning from private health insurance or three months. During the initial Medicare enrollment, Medigap policies are guaranteed issue, as well. The government is incentivizing Medicare Advantage plans; many Part C plans have no premiums. However, if your healthcare needs change and you want a Medigap plan, you likely won’t qualify due to medical underwriting for pre-existing conditions. Ironically the term pre-existing conditions only exist in the English language in the American healthcare system. Some areas have robust HMO options others don’t. An Advantage plan could be instead a disadvantage if you frequently travel because you are limited to a local HMO or face out-of-network charges.

For research, I test-drove the Medicare Plan Finder, the official government website that posts stand-alone drug (Part D), Medicare Advantage and Medigap offerings. I stumbled on my initial foray because I didn’t know the dosage of my one medication. Before going to the website, remember the Boy Scout motto, “Be Prepared,” and have all your prescriptions. Even on my second go-round, it frustrated me. The projected prices were much higher than what I currently pay. Supposedly the new and improved website makes it easier to compare options and shop for plans, but that was not my experience. Follow up with your pharmacist; it helped.

The government subsidizes Medicare coverage; to quote Mick Mulvaney, deal with it. Payroll deductions and surcharges on higher earners only fund Medicare Part A. Everything else Medicare-related is either fully or partially funded by general tax revenue. As people age, individual health insurance is impractical except for very healthy or fortunate people.

You can’t always get what you want, but Buz Livingston, CFP, can help you get what you need. For specific recommendations visit us online at or come by our office in Redfish Village, 2050 Scenic 30A, M-1 Suite 230.