Navigating Medicare can feel overwhelming, especially with changing rules, deadlines, and coverage options each year. As we move into 2025, it’s more important than ever to stay informed and avoid costly missteps that could impact your coverage—and your wallet.
Whether you’re enrolling for the first time or reassessing your plan, here are the top Medicare mistakes to watch out for —and how you can avoid them.
1. Missing Your Initial Enrollment Window
Your Initial Enrollment Period (IEP) begins three months before your 65th birthday and ends three months after, giving you a 7-month window to sign up for Medicare Part A and/or Part B.
Why this matters:
If you miss this window and don’t have other qualifying coverage (like through an employer), you may face late enrollment permanent penalties—and they will stick with you for life. Delaying enrollment can also mean gaps in coverage.
What to do:
Mark your calendar as your 65th birthday approaches and sign up on time—even if you’re still working, it’s important to understand how Medicare interacts with your current insurance. Check Creditable Coverage Section on our website (add internal hyperlink)
2. Assuming Medicare Covers Everything
While Medicare is a solid foundation, it doesn’t cover all healthcare costs. Many are surprised to learn that Medicare does not cover:
- Long-term custodial care (help with dressing, bathing, eating)
- Most dental care
- Hearing aids
- Routine vision care
- Prescription drugs (unless you have Part D)
What to do:
Consider adding Medicare Part D (prescription drug coverage), or enrolling in a Medicare Advantage (Part C) or Medigap (supplemental) plan to fill the gaps.
3. Not Reviewing Your Plan Annually
Your health needs change—and so do Medicare plans. Drug formularies, provider networks, premiums, and out-of-pocket costs can all shift from year to year. Every year, Medicare Advantage plans typically provide two key documents:
- Annual Notice of Changes (ANOC): This outlines any changes to the plan’s costs, benefits, and coverage for the upcoming year. It’s important to review this to see if your plan will still meet your needs.
- Evidence of Coverage (EOC): This document provides detailed information about what the plan covers, how much you’ll pay for different services, and your rights and responsibilities under the plan.
These documents are usually sent out in the fall, before the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. This gives beneficiaries time to review their options and make adjustments if necessary.
Supplemental Medicare Plans, also known as Medigap plans, generally do not send Annual Notice of Changes (ANOC) or Evidence of Coverage (EOC) documents. These plans are standardized by the federal government and offer consistent benefits across all states, so there are typically no annual changes to report. Instead, Medigap insurers may send renewal notices or other communications regarding premiums or policy updates.
Why this matters:
Staying on the same plan without reviewing could mean higher costs or reduced coverage.
What to do:
During the Annual Enrollment Period (Oct 15–Dec 7), review your plan carefully. Use the Medicare Plan Finder on Medicare.gov or speak to a licensed Medicare advisor to explore better options for the upcoming year.
4. Skipping Medicare Part D (Even If You Don’t Take Medications)
You might be healthy now, but if you don’t sign up for Part D when you’re first eligible and go without creditable drug coverage, you could face a lifetime late enrollment penalty if you sign up later.
What to do:
Enroll in a low-cost Part D plan during your initial window to avoid penalties down the road—even if you aren’t currently taking prescriptions.
5. Choosing Medicare Advantage Without Checking Your Doctors or Hospitals
Medicare Advantage (Part C) plans are often appealing because of added benefits (like dental, vision, or gym memberships). But these plans operate with network restrictions, meaning not all doctors and hospitals may be covered.
What to do:
Before enrolling in a Medicare Advantage plan, confirm that your preferred providers and pharmacies are in-network. Otherwise, you may face higher costs or be forced to switch providers.
6. Assuming You Don’t Qualify for Financial Help
Many people don’t realize that Medicare offers programs to help with premiums, deductibles, and drug costs—especially for those with limited income or assets.
What to do:
Look into programs like:
- Medicare Savings Programs. Medicare Savings Programs (MSPs) are federal initiatives administered by states to assist individuals with limited income and resources in affording Medicare costs. These programs help cover expenses such as premiums, deductibles, copayments, and coinsurance, thereby enhancing healthcare access for eligible beneficiaries. There are four main types of MSPs:
- Qualified Medicare Beneficiary (QMB): QMBs have the highest level of assistance, helping to pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB): SLMBs help pay for Medicare Part B premiums.
- Qualifying Individual (QI): QIs also help pay for Medicare Part B premiums.
- Qualified Disabled and Working Individuals (QDWI): QDWI programs help pay Medicare Part A premiums for certain disabled individuals who work and lost their Social Security benefits.
Eligibility requirements for these programs vary by state but generally depend on income and asset levels.
- Extra Help (Low-Income Subsidy) for Part D. The Low-Income Subsidy (LIS), also known as “Extra Help,” is a Federal Medicare program, administered by the Social Security Administration, and designed to assist people with limited income and resources in paying for Medicare Part D prescription drug costs. This subsidy can help lower expenses such as premiums, deductibles, copayments, and coinsurance associated with Medicare prescription drug coverage, making medications more affordable for those who qualify.
- State Pharmaceutical Assistance Programs (SPAPs) are state-funded programs that provide financial assistance with prescription drug costs to eligible individuals, typically those with low incomes and/or disabilities. These programs vary significantly from state to state in terms of eligibility criteria, covered drugs, and the amount of assistance provided. While the federal government sets some broad guidelines, each state has considerable flexibility in designing its own SPAP to meet the specific needs of its residents.
These programs can reduce or even eliminate certain Medicare costs.
7. Not Understanding the Differences Between Medicare and Medicaid
Medicare and Medicaid are two different programs. Medicare is primarily age-based (65+), while Medicaid is income-based.
Why this matters:
If you qualify for both (known as dual eligibility), you could receive more comprehensive coverage, but coordination of benefits is key to maximizing that support.
What to do:
Speak with a Medicare counselor or SHIP (State Health Insurance Assistance Program) representative to ensure you’re enrolled correctly and getting the most from both programs.
Final Thoughts
Medicare is a vital part of retirement, but making the wrong move—or failing to act—can lead to unexpected costs or gaps in care. By staying informed and proactive, you can make confident choices that support both your health and your finances in 2025 and beyond.
If you’re unsure about your options, don’t go it alone. Reach out to a licensed Medicare advisor, or take advantage of free counseling through your local SHIP office. A little preparation now can prevent a lot of headaches later.
Expert Guidance for Your Insurance Needs
Navigating Medicare and insurance options can be complex. For personalized assistance in selecting a plan that meets your health and financial objectives, contact a licensed professional. Visit https://sfib.net or call 786-303-8065 to connect with an expert dedicated to crafting a strategy tailored to your circumstances. Your future deserves a plan that matches your commitment—take the first step today.
