More than 70 million Americans are on Medicare. Whether you’re 65 or older or have an eligible disability, Medicare can be a necessary lifeline that helps reduce the costs of medical care, prescriptions, and more. But the amount of information and the necessary steps involved in signing up or navigating a potential change in your plan can be overwhelming. We talked with Danielle Roberts, co-founder and Medicare insurance expert at Boomer Benefits, about the mistakes you could be making when it comes to Medicare — and how to avoid them. 

Treating Medicare as a One-Size-Fits-All Benefit

Medicare isn’t the same for everyone. “Each person has their own eligibility, their own premiums, and their own enrollment timeline,” Roberts says. “Even within the same household, one spouse may be enrolled in Medicare while the other is not or may have completely different coverage rules.”

Regardless of whether you and your spouse are enrolling at the same time, or your friend recommends a certain type of coverage, it’s important to make Medicare decisions based on what’s right for you as an individual. “Get started on your Medicare research several months in advance of your Medicare eligibility,” Roberts recommends. “Medicare decisions affect coverage, costs, and, in some cases, tax planning, so the timing matters.”

Not Anticipating or Planning for Gaps in Medicare Coverage

Medicare, including Part A (hospital insurance) and Part B (medical insurance), isn’t comprehensive. “Part A and Part B still include deductibles, copayments, and coinsurance,” Roberts says. “For example, Part B generally covers 80% of approved outpatient services, leaving the remaining 20% as the beneficiary’s responsibility.”

Whether you’re considering Medicare or planning to switch to another Medicare plan, focus on the services you’ll use. For example, most Medicare plans don’t include coverage of vision, hearing, and long-term care, according to Roberts. In that case, you may want to opt for one of the Medicare Advantage plans (Part C) that do include these services. Make sure to review them carefully to ensure they include your preferred doctors.

Contributing to HSA Accounts

If you’ve enrolled in Medicare Parts A and B or a Medicare Advantage plan, you can no longer contribute to a Health Savings Account (HSA). Roberts says she often sees confusion about HSAs and Medicare. “Many people continue contributing to an HSA … without realizing the rules change at enrollment. Once Medicare begins, HSA contributions are no longer allowed. Continuing contributions can create unnecessary tax issues that are entirely avoidable with proper timing.”

If you’re 65 or older, still working, and want to continue contributing to your HSA, you can delay enrolling in Medicare. Be aware, however, that there can be penalties for delaying enrollment, and if you delay, your  HSA contributions will need to stop six months before you ultimately apply for Medicare, Roberts says.

But if you’re enrolling in Medicare at 65, according to Roberts, “you can keep contributing to your HSA all the way up until the day before your 65th birthday month.” The good news is, no matter when you join, you can still use your existing HSA funds for expenses such as copays and deductibles. 

Not Confirming How Medicare Works Alongside Employer Health Plans

If you’re working past 65 and have employer-sponsored medical coverage, Medicare still matters. Roberts often sees people misunderstand how Medicare works alongside other coverage. “Employer plans and retiree coverage do not always function the way they did before age 65,” she says.

Once you turn 65, find out from your employer whether you need to sign up for Part A or Part B. “Depending on employer size and plan rules, Medicare may be primary or secondary, and that order determines how claims are paid,” Roberts explains.

Delaying Medicare Because of Other Plans

“Another common mistake is delaying Medicare because of COBRA or a retiree health plan,” Roberts says. “These types of coverage do not allow you to safely delay Medicare enrollment. It often results in lifelong late enrollment penalties or gaps in coverage.” (You can decline to enroll in Medicare entirely, but according to Heathline, doing so will require you to decline other monthly benefits such as Social Security, and you’ll also need to repay what you’ve already received.)

Contact your health insurance provider for more information if you’re unsure whether to sign up for Medicare given your current coverage. If you have post-employment COBRA coverage, your next steps may vary. The U.S. Centers for Medicare & Medicaid Services provides specific guidelines based on your current coverage and has an easy quiz to help confirm next steps.

Missing the Correct Enrollment Period

Another big mistake, according to Roberts, is missing your correct enrollment window. “Medicare has several enrollment periods every year, which can be confusing,” she says. “However, your Initial Enrollment Period is the most important one.” 

Your Initial Enrollment Period begins three months before you turn 65 and lasts three months after, lasting seven months total. “There can be permanent penalties and gaps in coverage if a beneficiary doesn’t enroll within their allotted window and has other creditable coverage,” Roberts says. 

Many people also miss their Medigap Open Enrollment window. Medigap is the additional coverage from private companies that you can purchase to fill gaps in Medicare. There is a onetime period when you can buy a Medigap plan without medical underwriting. Once that window closes, “the underwriter can decline you for health reasons unless you live in one of the few states with Guaranteed Issue rights, allowing residents to buy a Medigap without having to pass underwriting during certain times of the year,” Roberts says.

Research your Medicare enrollment window before you turn 65, and base your decisions on your current coverage. If you’re looking to switch Medigap plans, take this quiz offered by the U.S. Centers for Medicare & Medicaid Services to understand your options.

Missing Your Yearly Review

Roberts advises reviewing Medicare every year. “A brief yearly review helps prevent unexpected costs and ensures coverage still fits your needs,” she says. 

Renewals can happen automatically unless you make changes. “Each fall, beneficiaries receive an Annual Notice of Change (ANOC) outlining updates for the coming year,” Roberts explains. “Check your Annual Notice of Change that arrives in September and compare the full picture, deductibles, copays, and whether your specific medications and doctors are still covered.” She recommends changing if your plan is “dropping one of your important medications next year, your Advantage plan is dropping your doctor from its network, or your plan has a drastic increase in premiums.”

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Long before memory lapses become noticeable, the earliest signs of dementia may show up somewhere unexpected: a person’s bank account.

In America alone, more than 6 million people are living with dementia. Typically, patients begin noticing telltale symptoms such as memory loss and challenges with word recall about three and a half years before they are officially diagnosed. But a new analysis suggests that changes in financial behavior may begin years before a formal diagnosis, potentially offering an early warning sign of cognitive decline.

“Dementia is one of the diseases where you lose a lot of cognitive capabilities over time that are unfortunately closely tied to our ability to manage our own money,” Lauren Nicholas, one of the study’s authors and a health economist and professor of geriatrics at the University of Colorado, told NPR. “We actually see that some of the earliest signs show up in your financial portfolio and your checkbook and kind of not in the standard tests your doctors are doing.”

An Early Warning Sign 

To better understand when and how wealth decline may serve as an early sign of dementia, Nicholas and several colleagues from institutions across the nation analyzed nearly 20 years of data from the Health and Retirement Study to compare the financial behaviors of people who were later diagnosed with dementia with those of people who were not. 

Their findings, which were published in January, pointed to a striking conclusion: People who eventually developed dementia began to see their wealth diverge from that of otherwise similar adults about six years before the condition became clinically recognizable. Those losses were largely relegated to investment accounts, stocks, bonds, and mutual funds — assets that generally require ongoing attention and active decision-making. Checking and savings accounts saw losses as well.

The analysis found little evidence that the decline was driven by outside factors such as reduced earnings, increased health care expenses, or intentional spending. Instead, the researchers concluded that subtle cognitive changes may impair financial judgment and decision-making long before memory problems become apparent enough to prompt a medical diagnosis, or to even seek a doctor’s opinion.

The Bright Side

The findings also suggest that many older adults may not recognize their own cognitive decline. However, there was one encouraging takeaway: People who received a timely memory-related diagnosis appeared to successfully stabilize their finances afterward, suggesting that early intervention and help with money management can make a meaningful difference before small mistakes become costly ones.

Nicholas and her colleagues believe these financial warning signs are unique to dementia, because those in the analysis who were diagnosed with other diseases such as cancer did not see a similar decline in the wealth of their households pre-diagnosis.

“Some personality changes happen early in the course of cognitive decline, which can include propensity to trust people, your risk tolerance,” she told NPR. “What happens commonly is …  even though you’re losing these capabilities, starting to forget about making your bill payments or something, you’re actually getting more confident in your abilities, and … you think you’re crushing it.”

In the future, Nicholas told NPR that the researchers would like to develop a model that looks at activity on credit reports, for example, and creates a financial dementia score that a physician can access to determine if further evaluation is needed. But, as the paper notes, “Addressing this risk requires coordination across multiple sectors, including health care, financial institutions, legal services, and policymakers,” and Nicholas believes a solution is at least a few years away. 

But that doesn’t mean that there’s nothing you can do to protect yourself. In the paper, the authors underscore the importance of putting safeguards — such as simplifying financial accounts or involving family members in financial decision-making — in place before cognitive problems become apparent. The sooner families recognize potential cognitive changes, the more opportunity they have to protect hard-earned savings.

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