By Jackie Tangires, LCSW-C, Certified Aging Life Care Manager
Are you approaching Medicare enrollment or helping a loved one navigate these crucial healthcare decisions?
Medicare offers a range of plans, and understanding the available options can make a big difference in securing the right coverage for 2026.
If you are eligible for Medicare while still working and covered by an employer group health plan, you should avoid a costly mistake. Read more from this KFF Health News article https://kffhealthnews.org/news/article/medicare-age-65-group-employer-health-coverage-coordination-benefits-surprise-bills/ to help you or your loved one make informed choices before enrolling in Medicare.
What Is Medicare?
Medicare is the federal health insurance program for:
- Adults 65 and older
- People under 65 with disabilities
- Individuals with End-Stage Renal Disease (ESRD) or ALS
It helps pay for healthcare—but it’s not entirely free and doesn’t cover everything.
The Four Parts of Medicare
Part A – Hospital Insurance
Covers hospital stays, skilled nursing care, hospice, and some home health services. Usually free if you’ve paid Medicare taxes.
Part B – Medical Insurance
Helps cover doctor visits, outpatient care, and preventive services—monthly premium required.
Part C – Medicare Advantage
Offered by private insurers. Combines Parts A & B, often Part D, and may include extras like dental, vision, or hearing.
Part D – Prescription Drug Coverage
Helps pay for medications. Offered by private insurance companies.
Medicare Part D and Medicare Advantage plans automatically renew each year on January 1 unless you make a change. While this can simplify things, it’s essential to evaluate your options yearly. Coverage, deductibles, premiums, and other costs can change significantly.
Please note that Medicare enrollment occurs only once a year, and the enrollment period ends on December 7, 2025. Reviewing your options now can help avoid unexpected costs.
Take Charge Today
- Review any changes to your current plan’s coverage for 2026.
- Check for alternative plans that may better suit your medical needs and budget.
- Explore financial assistance options if you need help with premiums.
- Enroll in your plan. Open enrollment ends on December 7, 2025.
Avoid These Common Mistakes
Allowing Automatic Plan Renewal to Make Your Decision for You
- Your Medicare Part D or Medicare Advantage plan renews annually on January 1, unless you decide to make a change. While automatic renewal may seem convenient, it might not be the best way to make your Medicare decisions. Plans may change their coverage yearly, including deductibles, premiums, copays, and coinsurance amounts. Insurance companies review their plans annually to ensure they remain viable. Shouldn’t you do the same?
Ignoring Your Plan’s Annual Notice of Changes (ANOC)
- Each fall, you receive an Annual Notice of Changes (ANOC) from your Medicare Part D or Medicare Advantage plan. This document details changes to your plan’s benefits or costs for the upcoming year. These changes can impact your healthcare and budget, so review your ANOC closely to understand what’s changing.
Focusing Only on the Premium When Choosing a Plan
- It’s easy to focus solely on premiums when comparing Medicare costs. However, it’s essential to consider the big picture. A plan with a low or $0 monthly premium may have a deductible for medical or prescription drugs or higher copayments. This plan may work if you rarely visit the doctor or take a few medications. When selecting a plan, consider all out-of-pocket costs in conjunction with your healthcare needs. For example, many Medicare Advantage plans include routine vision, hearing, and dental coverage, which Original Medicare does not typically cover.
Choosing a Plan Based on Someone Else’s Experience
- While you might trust a friend’s opinion about a new restaurant, selecting a Medicare plan is highly personal. What works for one person may not suit another’s needs. With several plans available, reviewing all your options is wise, keeping your healthcare needs and budget in mind. Coverage and costs can vary significantly from plan to plan.
Assuming You Don’t Qualify for Medicare Financial Assistance
- Several programs provide financial assistance with Medicare premiums and other costs. Even if you may not qualify, it’s worth exploring these options. Contact your State Health Insurance Assistance Program (SHIP) office to discuss your situation. Your health insurer may also offer programs and services to help manage expenses.
What You Need to Know to Avoid Traps
- If you’re 65+ and work for a company with fewer than 20 employees, you must enroll in Medicare (Parts A and B), even if you have job-based coverage.
- If you delay enrolling, Medicare won’t pay retroactively for your care, and your employer plan will likely not cover the costs either.
- COBRA and retiree health plans don’t count as creditable coverage for delaying Medicare.
- There’s little to no notification from insurers or employers warning people of this rule, and the guidance is buried in hard-to-understand Medicare handbooks.
- It’s recommended to contact Medicare or a State Health Insurance Assistance Program (SHIP) when nearing 65 to avoid surprises. If you were misinformed, you may qualify for a Special Enrollment Period, but relief isn’t guaranteed.
How Can The Option Group’s Aging Life Care Managers Help You Today?
The Option Group’s Certified Aging Life Care Managers help families navigate the challenges of aging, dementia, disability, and serious illness. With over 100 years of combined experience, we connect you to the right resources, so you can focus on quality time with your loved ones and make informed care decisions.
Final Thought
Medicare enrollment has become increasingly complex. Taking the time now to review your options can ensure you have the right coverage for the coming year, giving you peace of mind as you navigate your healthcare needs.
If you or someone you care about needs additional support to help cope, The Option Group is here to help. Don’t hesitate to contact our professional care management team for assistance.
About The Option Group: Founded in 2011, The Option Group’s compassionate team of experienced Certified Life Care Managers provides services for families, their loved ones, medical professionals, and professional family advisors in Maryland, DC, Southern Pennsylvania, and Delaware. The firm understands the challenges of caring for individuals who need assistance throughout their lifespan due to aging, dementia, disability, or serious illness. Our skilled providers, from a variety of backgrounds and deep expertise, help families navigate the healthcare maze and access hundreds of resources. The Option Group helps families spend quality time with their loved ones, providing Clear Choices that lead to Better Care. For more information, visit www.theoptiongroup.net or call 410-667-0266 (MD), 717-287-9900, 610-885-8899, or 215-896-6756 (PA), or 302-858-6449 (DE).