With Medicare, One Size Does Not Fit All

Arriving at a conference, I went to hang my coat on the rack and noticed one that was almost identical to mine. I hung my coat as far away from that one as possible. A couple of hours later while heading to a session, I noticed a woman wearing my coat. She was furiously checking the pockets and saying to her companion, “My keys aren’t here.” I walked up to her and politely said, “Your keys aren’t in the pocket because that’s my coat.” It fit her but didn’t meet her needs.

Many people don’t want to deal with Medicare. It takes time they would rather not spend. So, the idea of following another person’s lead may seem easy and convenient, but it likely won’t be the right thing to do.

Here are three examples, based on real-life situations, that demonstrate the importance of making your own decisions.

Choosing the same Medicare Advantage or Part D drug plan as a spouse.

Just about everyone has had coverage through an employer group health plan sometime in their lives. The plan’s package of benefits and costs applies to anyone who has the coverage, without consideration of an individual’s unique situation or needs. Spouses can have the same coverage as the employee.

That changes in the Medicare world. Medicare is a one-person, one-plan deal. Your Medicare plan cannot cover your spouse, children, or partner. And, unlike the typical employer coverage with just one plan, there are many Medicare options (maybe too many) available.

Best advice: Find coverage that will work for you, not only when you are spry and healthy at age 65, but down the road, as you age and face health challenges. This probably won’t be the same coverage your spouse or best friend has.

(One exception: It’s okay to enroll in the same Medigap policy as your spouse. This coverage helps pay the costs that Medicare Part A and Part B don’t, like the hospital deductible and 20% coinsurance. Some plans offer a household discount, a reduced premium when two people living at the same address purchase a policy from the same insurance company.)

Signing up for Medicare at the same time as someone who is in a similar situation.

The number of Medicare enrollment periods can boggle the mind. There are three for just getting into Medicare initially.

There’s no doubt that taking the same course as someone else is easier. For instance, your friend has the same birthday as you and enrolls in Medicare at age 65 so you do, too. However, he has retiree coverage and you are still employed. Too different situations dictate two different enrollment decisions.

Best advice: When approaching age 65, figure out what you need to do about Medicare. Then, make a plan and give yourself enough time to get Medicare right.

Enrolling in a drug plan and Medigap policy (Medicare supplement insurance) sponsored by the same insurance company.

Many well-known Medicare supplement insurance companies also sell Part D drug plans in most areas. For example, in a Florida city, the Medicare Plan Finder notes one Medigap insurer offers two drug plans with monthly premiums of $80 and $170. There are 15 plans, sponsored by other companies, with lower premiums (starting at $9). All drug plans work the same way. The company name may be important but is it worth it?

Best advice: Every year during the Open Enrollment Period, check out available plans and find the one that best fits your current medication regimen.

It’s doubtful that you would have someone else pick out a coat for you. So don’t let that happen with Medicare. Make your own decisions and get coverage that fits when you need it.