Common Pitfalls

When making decisions about Medicare, make sure you understand its costs, which can include:

• Premiums, a monthly amount that has to be paid whether or not you use medical services. Medicare premiums may be deducted directly from your Social Security Disability Insurance (SSDI) or Social Security retirement benefits.
• Copayments, a set amount you have to pay for a medical visit or service. The exact amount of the copayment depends on the service you get: Medications, visits to specialists, lab tests, X-rays, emergency room visits, and other services can all have different copayment amounts.
• Co-insurance, a set percentage of the cost of a visit or service that you must pay.
• A deductible, a set amount of money that you pay out of your own pocket each year before Medicare begins to pay for certain expenses. Once you have paid the deductible, you do not have to pay it again until the next calendar year.

Learn about programs that may help you with these costs.

For most people who get Original Medicare, Part B has a $185.00 monthly premium (it could be a bit less; the exact amount depends on your situation) and Part D prescription drug coverage also has a premium (the amount depends on your Part D plan).

You may want to opt out of Part B and Part D to save money on monthly premiums, especially if you have other coverage and don’t think you need the sorts of medical services and prescription drugs they cover. However, if you decide you don’t want Parts B and D and you change your mind later, you might have to pay large premium penalties.

Here's when you might be able to opt out:

• For Part B: If you have an employer-sponsored insurance policy, check with your employer or insurer whether it's safe for you to opt out of Part B.
  • Note: This does not apply to retiree or COBRA coverage. It's only if you or your spouse has employer-sponsored coverage through a current employer.
• For Part D: You have to have creditable coverage. That means your prescription drug coverage is as good as Part D. Not all plans are considered creditable by Medicare; you have to check with the plan administrator.
  • Note: Even if you have other coverage, it might still make sense to keep Part D if you also qualify for Medical Assistance (MA), a Medicare Savings Program (MSP), or the Part D Low Income Subsidy (also called Extra Help). They may help pay for Part D and so your overall coverage is better.

Important: If you also have MA or MA-EPD coverage, do not decline Part B or Part D coverage. If you decline them, MA (or MA-EPD) won't pay for what they would have covered.

Learn more about getting help paying for Medicare.

Medicare Savings Programs (MSPs) help people with low income and low assets pay Medicare premiums. Depending on the MSP, it may also help with other expenses, such as copayments, co-insurance, and deductibles.

• For people with Original Medicare, MSPs can help with Parts A and B.
• MSPs can help with any Medicare Advantage plan.

The Low Income Subsidy (LIS), often called Extra Help, helps people with low income and low assets pay premiums, copayments, co-insurance, and deductibles for Medicare prescription drug coverage:

• For people with Original Medicare, the LIS can help with Part D plan expenses.
• The LIS can help with Medicare Advantage plans that include prescription drug coverage, sometimes called MA-PD plans.

You may qualify for an MSP or the Low Income subsidy and not know. Many people who qualify for them never apply. Even if you think you won’t qualify, make sure to apply! They can be a big help. Note: If you have both Medical Assistance (MA) and Medicare coverage, you may automatically get help from an MSP and the LIS.

If you have any questions about Medicare Savings Programs and the LIS, call the Senior LinkAge Line® at 1-800-333-2433.

Learn more about getting help paying for Medicare and how to apply for it.

If you have more than one type of coverage, one coverage may pay for costs that your other coverage doesn't pay for, meaning you have to pay less out of your own pocket.

Other types of coverage that you can have with Medicare include:

• Medical Assistance (MA)
• Medical Assistance for Employed Persons with Disabilities (MA-EPD)
• Employer-sponsored coverage
• Continued coverage from a former employer through COBRA
• Retirement plans
• Veterans (VA) benefits
• Military (TriCare for Life) benefits, or
• Individual health insurance.

You cannot get MinnesotaCare coverage if you qualify for Medicare.

Learn more about how Medicare interacts with other types of coverage.