Starting a new Medicare plan can feel exciting—but overlooking key details can lead to higher costs and unnecessary stress. Avoid these common mistakes to make sure your plan works for you.
1. Assuming your doctors are covered
One of the biggest mistakes is not checking if your doctors and hospitals are in-network. Out-of-network care often means higher bills and more hassle.
Avoid it: Use your plan’s online directory to confirm your providers are in-network.
- Priority Health members can use the Find a Doctor tool to search for in-network providers by name, location or facility.
2. Ignoring prescription drug coverage
Skipping a review of your drug coverage can lead to expensive surprises at the pharmacy. Formularies change every year, and not all pharmacies offer the same pricing.
Avoid it: Check your plan’s drug list and confirm your pharmacy is a preferred pharmacy to save on costs.
- Priority Health members can use the Approved Drug List to search for covered drugs and save more at preferred pharmacies.
3. Focusing only on the premium
A low or $0 premium sounds great—but ignoring deductibles, copays and coinsurance can blow your budget later.
Avoid it: Review your plan’s out-of-pocket maximum and cost-sharing details upfront.
- Priority Health members can track spending and deductible progress in their member account.
4. Skipping prior authorization
Some services—like imaging, rehab or surgeries—require prior approval. Forgetting this step can result in denied claims and unexpected bills.
Avoid it: Before scheduling care, check if prior authorization is needed. Your doctor’s office can help with the process.
- The purpose of prior authorization is to make sure you receive services that are medically and clinically necessary, and that the services are appropriate for your condition or diagnosis.
5. Forgetting to review your plan annually
Plans change every year—networks, drug coverage and costs. Sticking with the same plan without reviewing can mean you’re missing out on better options.
Avoid it: Compare plans during Medicare Open Enrollment (Oct 15–Dec 7) to make sure your coverage still fits your needs.
- Get guided help choosing a Priority Health Medicare plan.
Why understanding your plan matters
Your Medicare plan is an important part of your health and financial well-being. Taking time to understand your coverage helps you avoid surprises, save money, and get the care you need—when you need it.