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October 11, 2013

Consumer Reports: Avoid expensive health insurance mistakes

(Continued)

But the fine print can cost you if you're not careful. For instance, if your PPO says it will pay 60 percent of the cost of out-of-network care (compared with, say, 80 percent for in-network care), it will pay 60 percent of whatever it determines is a "reasonable" price for the service — not 60 percent of whatever the doctor decides to charge. So if his fee is $2,000 and your insurance company decides that the fair price is $1,000, it will reimburse you only $600, leaving you on the hook for the other $1,400.

4. Don't miss the Medicare sign-up deadline. If you're already retired or plan to retire at 65, Medicare enrollment is a no-brainer: Sign up during the month you turn 65 or the three months before or after.

Where people get in trouble is when they, or a spouse, continue working past their 65th birthday. As long as you or your spouse works at a job with health benefits and there are 20 or more employees, you will probably get little or no benefit from being on Medicare. That's because Medicare pays secondarily to your employer's group plan.

But once you (or your spouse) stops working and you lose your insurance — even if you can continue with the employer plan through COBRA or some other retiree benefit — you must switch to Medicare as your primary insurance. You need to sign up within eight months after you stop working. If you don't and your private plan finds out, it can refuse to pay for your health care.

It gets worse. If you don't sign up for Medicare when you should, you'll be hit with a permanent 10 percent premium surcharge for every year you should have been on Medicare but were not.

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