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Common Medicare enrollment mistakes before the Dec 7 deadline

Medicare open enrollment runs through December 7, and these common errors can cost seniors money and access to care

Medicare plans rewrite their own terms every year, whether or not anyone is paying attention. Premiums, deductibles, drug formularies, pharmacy tiers, provider networks and out-of-pocket maximums can all shift on January 1. A plan that was the cheapest option one winter can turn into one of the costliest the next. None of that requires the beneficiary to make a wrong move. It only requires a renewal notice to go unread.

Open enrollment runs from October 15 through December 7. During that window, most people on Medicare can switch plans, change prescription drug coverage or move between Original Medicare and Medicare Advantage, with no health questions asked. The window then closes on its own, and coverage rolls into the new year on the insurer's terms rather than the enrollee's.

The consequences are concrete. The wrong Part D plan can add hundreds of dollars a year in costs for the same set of prescriptions. A Medicare Advantage plan that has dropped a hospital system or a longtime specialist can cut off access to a doctor in the middle of treatment. Missing the deadline usually means waiting a full year for another chance to change coverage. With Part B, enrolling late without qualifying coverage elsewhere can attach a permanent penalty to a monthly premium.

What follows are 10 Medicare open enrollment mistakes that surface year after year. They range from ignoring the Annual Notice of Change that arrives each fall to misunderstanding which enrollment window actually applies. None are hard to fix. Most come down to an hour with Medicare's official plan finder or a call to a doctor's office to confirm network status. Free counseling is another option: the State Health Insurance Assistance Program, known as SHIP, operates in every state. The aim here is not to point anyone toward a particular plan, since the right choice depends on health needs, prescriptions and budget. It is to name the recurring, avoidable missteps that leave people overpaying, cut off from their own doctors or stuck for 12 months with coverage that no longer fits.

Assuming last year's plan still fits this year

The most common Medicare open enrollment mistake is doing nothing. Automatic renewal keeps a plan in force, but it does not preserve the terms that made the plan worth choosing. Every Medicare Advantage and Part D plan can revise its premium, deductible, cost-sharing, drug list and provider network for the coming year.

Those revisions are spelled out in the Annual Notice of Change, which plans send to current members each fall before enrollment opens on October 15. Inside are the details that determine whether the plan still fits: drugs added to or dropped from the formulary, medications moved between cost-sharing tiers, a new out-of-pocket maximum, and pharmacies or providers leaving the network.

A plan can keep its name and still work differently in January. A deductible can rise. A maintenance medication can shift to a higher tier and cost several times more per fill. A preferred pharmacy can become a standard one, which raises the copay at the counter without anything changing on the member's ID card.

Reading the notice establishes the baseline for every other decision. The second step is measuring that baseline against one or two alternatives on Medicare's official plan finder at medicare.gov, which lists every Medicare Advantage and Part D plan sold in a given ZIP code. The comparison is worth running even for people satisfied with their current coverage, because that satisfaction reflects this year's terms rather than next year's.

Plans also exit markets or merge. When a Medicare Advantage or Part D plan is discontinued in a service area, members are notified and need to select new coverage, and those who do not act can end up back in Original Medicare with no drug plan attached. Finding that out in October leaves weeks to choose deliberately instead of defaulting into whatever comes next.

Treating open enrollment as an annual review, rather than a decision made once and left alone, is the difference between seeing a cost increase in advance and discovering it in January, when a claim is denied or a refill costs more than expected.

Not checking whether a preferred drug is still covered

A drug covered by a Part D or Medicare Advantage plan this year is not guaranteed to be covered next year, or covered at the same price. Formularies are rewritten annually, and checking next year's list directly is the only way to know what a prescription will cost in January.

Plans sort covered medications into tiers, and a drug can move from a lower, cheaper tier to a higher one while remaining on the formulary. That reclassification alone can raise a monthly copay substantially. A medication can also be dropped outright. That leaves two options: switch to an alternative the plan covers, or file a formulary exception request and wait for a decision.

Plans can also attach prior authorization requirements, step therapy rules or quantity limits to a drug that had none before. Those restrictions create delays at the pharmacy counter even when the drug stays covered.

Specialty medications carry the most exposure. The gap between how one plan treats a given drug and how another treats it can be large enough to reshape a year's budget. Anyone taking several maintenance prescriptions faces the same risk multiplied. One unfavorable tier change on each of four or five drugs adds up fast.

The practical step is to enter every current prescription into Medicare's plan comparison tool, including the exact dosage and the frequency. Then review the results against the plans on offer for the coming year rather than relying on this year's experience. Dosage matters, since quantity limits and tier placement can........

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