Seven Steps to Medicare Mastery

October 21, 2021

Seven Steps to Medicare Mastery 

Medicare Open Enrollment begins October 15, and it’s no secret the maze of options, caveats, and fine print can be positively overwhelming. An ill-fitting plan or missed deadline can make it much harder to keep up with simple healthy habits. What’s more, research shows that adequate medical coverage, medication compliance, and financial stability are all risk factors associated with institutionalization. 

Here are seven steps for seniors and their care teams to mastering Medicare, a key to keeping older adults independent for as long as possible.

1. Don’t Go It Alone

First and foremost, find out about free counseling services in your area, such as the State Health Insurance Assistance Program (SHIP). Hear objective advice from a volunteer at a location in your community or by calling 1-877-839-2675. Resources abound online, including The Medicare Rights Center’s Medicare Interactive and The National Council on Aging’s My Medicare Matters. 

2. Mark your Calendar

Believe it or not, it’s common for people to be completely unaware of their initial opportunity to enroll in Medicare, which is three months before their 65th birthday. Unfortunately, late enrollment penalties can last for years. For example, if you didn’t pick up Medicare Part A until two years after initial eligibility, expect to pay a 10% penalty for four years. Open Enrollment is the window to make changes and is the same time every year—October 15 through December 7. 

3. Set Aside Some Time

It’s important to give a fair amount of attention to reading and comparing options each year. Even if you were satisfied with your coverage over the past year, new plans become available every year, and those not-so-obvious changes in personal circumstances might benefit from a change in coverage. Changing budgets, medications, living environments, and travel plans may be a reason to look for different benefits for the year ahead.

4. Look at the Big Picture 

Before you even think about sitting down with Medicare & You, the free handbook made available every year from the U.S. Government, reflect on your outlook today. Take a step back and set big picture goals. Are you interested in checking out wellness programs? Looking for more predictability in costs? What are the unresolved issues you’ve been worried about? Finding the right Medicare plan is easier when you’ve envisioned the outcomes you want.

Watch-Out #1: Who Pays First?

Don’t let an unexpected co-payment ruin your day! When you need services, you might be paying 100% from your own wallet. Plans with a low premium typically come with a higher deductible. Know the difference between the predictable co-payment (a flat fee paid at the time of service) and co-insurance (a percentage of the service cost), which can vary widely.

Watch-Out #2: Medigap Enrollment Timing

There are two broad categories of Medicare plans: Medicare Advantage and Original Medicare with Medigap as an optional supplement. Basically, you get one year to try out Medicare Advantage before you can switch back to Original Medicare and still be guaranteed eligibility for a Medigap plan. If you’ve been enrolled in a Medicare Advantage plan for more than one year and decide to switch to Original Medicare, expect Medigap coverage to cost more or, even worse, be unavailable if you are dealing with certain medical issues. 

Watch-Out #3: Minor Changes to Plans 

Keep an eye out for your plan’s required Annual Notice of Change. Some key things to check are your medications (that they’re still on formulary) and premium and out-of-pocket costs. Also check the star ratings of your plan for any red flags—ratings are published by Centers for Medicare & Medicaid Services (CMS) with various metrics to track performance year-over-year and compare offerings. 


Adequate medical coverage is scientifically proven to impact independence among older adults. Service providers across the U.S. have adopted PFMIpro to track this and other risk factors, empowering professional caregivers to deliver appropriate support and data-driven updates to care teams and loved ones. With real time reporting capabilities, agency administrators can also track and report critical performance metrics to funding sources. Connect with the experts and request a demo at