Description
Book SynopsisMedicare madesimple
Medicare brings valuable benefits to more than 58 million people and growing, but most of us don't even know the basics of how Medicarecanworkbest for us.That'swhereMedicare For Dummies, 4thEditioncomes in,explaining howthis complexsystem functions and helping youconfidentlynavigate your way through the mazetoget the most out of your coverage.
This indispensable resourceuntanglesMedicarein friendly, straightforward language.Stepbystep, you'll learnwhenand howto enroll,waysto avoid costly mistakes, andhowtofindthe plan that brings the most benefit to you and your family.
- Reduce out-of-pocket expenses
- Know your rights and protections
- Choose the best policy for you
Using this reassuring and comprehensive guide, you'll be able to get the answers to all your questions,find guidance on how to actandthenget on with getting the benefits you need.
Table of ContentsIntroduction 1
About This Book 2
Foolish Assumptions 3
Icons Used in This Book 4
Beyond the Book 4
Where to Go from Here 5
Part 1: Getting Started with Medicare 7
Chapter 1: The Nuts and Bolts of Medicare: What It Is and How It Works 9
Addressing Some Upfront Questions 10
Coming to Terms with the ABCs (and D) of Medicare 12
Part A 13
Part B 14
Part C 15
Part D 15
Recognizing That You Have Choices and Must Make Timely Decisions 16
Chapter 2: Spelling Out What Medicare Covers (A Lot, but Not Everything) 19
Understanding What Part A and Part B Cover 20
Necessary medical care 20
Preventive care 21
Specialized care in certain circumstances 24
Medical supplies and equipment 28
Knowing What Part D Covers 30
Making sense of drug coverage that can vary throughout the year 30
Finding out about formularies 32
Determining when drugs are covered by Part A, Part B, or Part D 34
The Gaps: Discovering What Medicare Doesn’t Cover 35
Routine hearing, vision, dental, and foot care 35
Home safety items 36
Nursing home care 37
Medical services abroad 38
Services that may be nice but aren’t necessary 38
Distinguishing When Coverage Comes with Limits 39
Limits on hospital stays 40
Limits on skilled nursing facility stays 41
Limits on mental health benefits 41
Limits on therapy services 42
Chapter 3: Understanding What You Pay Toward Your Costs in Medicare 45
Boning Up on Premiums, Deductibles, and Co-payments 46
Part A costs 47
Part B costs 49
Part D costs 50
Medicare Advantage costs 51
Paying Higher-Income Premiums 52
Understanding who’s liable for the surcharges 53
Figuring out what the surcharges cost you 56
Getting the surcharges waived 57
Paying Different Premiums than Other People in Certain Years 59
Paying Medicare Taxes While Receiving Medicare Benefits 61
Chapter 4: Reducing Your Out-of-Pocket Expenses in Medicare 63
Purchasing Medigap Insurance 64
Examining Medigap policies 65
Choosing and buying a Medigap policy 70
Qualifying for Help from Your State 70
Medicaid 71
Medicaid medical spend-down programs 72
Medicare Savings Programs 73
PACE plans 74
State Pharmacy Assistance Programs 75
Examining Whether Extra Help Can Lower Your Drug Costs 76
Qualifying for Extra Help 77
Applying for Extra Help 78
Choosing a drug plan with Extra Help 85
Considering Other Ways to Cut Costs 88
Taking income tax deductions for Medicare costs 88
Lowering drug costs without Extra Help 90
Part 2: The Hows and Whens of Medicare 93
Chapter 5: Qualifying for Medicare 95
Hitting the Milestone of Age 65 96
Debunking some qualification myths 96
Meeting the requirements for Parts A, B, and D 97
Qualifying for Part A on your own work record 98
Being eligible for Part A on someone else’s work record 100
Qualifying for Medicare under Age 65 on the Basis of Disability 102
Receiving disability payments 103
Suffering from permanent kidney failure (ESRD) 105
Living with Lou Gehrig’s disease (ALS) 106
Falling through the Cracks: Health-Care Options if You Can’t Get Medicare Yet 106
Nice work if you can get it: Landing a job with benefits 106
Paying for COBRA temporary insurance 107
Purchasing individual insurance through the online Marketplace 107
Buying health insurance outside of the Obamacare Marketplace 109
Getting health care without insurance 110
Chapter 6: Enrolling in Medicare at the Right Time for You 111
At a Glance: Surveying Situations That Affect Enrollment Timing 112
Understanding Your Initial Enrollment Period 114
Using your IEP at age 65 114
Taking advantage of your IEP when you have disabilities 115
Delaying Part B if You’ll Qualify for a Special Enrollment Period Later 116
Being able to delay Part B without penalty 117
Knowing what to do about Part A if you delay Part B 119
Heeding a special warning if you have a health savings account at work 120
Using the special enrollment period 122
Enrolling in Other Specific Situations 123
You’re a legal permanent resident 123
You live outside the United States 124
You’re in a nontraditional marriage or domestic partnership 127
You’re incarcerated 128
Deciding Whether and When to Sign Up for Part D Drug Coverage 129
Assessing drug coverage you have from elsewhere 129
Debating whether you need Part D if you don’t take medications 131
Figuring the best time to enroll in Part D 132
Understanding the Consequences of Not Signing Up at the Right Time 133
Missing your deadline for Part B 135
Passing your deadline for Part A 138
Neglecting your deadline for Part D 140
Figuring out whether you can get a late penalty revoked 142
Chapter 7: Discovering How to Sign Up for Medicare 145
Being Automatically Enrolled in Medicare Parts A and B 146
Sign Me Up! Applying for Medicare Parts A and B 147
Signing up from inside the United States 148
Enrolling while you’re living abroad 152
Opting Out of or Disenrolling from Part A or Part B 153
Declining Part A 154
Opting out of Part B 155
Disenrolling from Part B 157
Knowing When Your Coverage Begins 158
When you sign up during the first three months of your IEP 160
When you sign up during IEP months four through seven 160
When you are awarded Medicare coverage retroactively 161
Transitioning from Obamacare to Medicare 162
Figuring out whether you need to make the switch 163
Knowing how and when to switch from Marketplace to Medicare 165
Chapter 8: Understanding How Medicare Fits In with Other Health Insurance 169
Understanding Medicare’s Coordination of Benefits System 170
Helping Medicare help you: Filling out your initial enrollment questionnaire 171
Keeping Medicare informed if your coverage changes 172
Seeing How Medicare Works with an Employer’s Health Insurance Plan 172
Working with insurance from a current employer 173
Having insurance from a former employer 176
Figuring Out How Other Federal Health Benefits Fit In with Medicare 180
The Federal Employees Health Benefits Program 180
TRICARE and TRICARE For Life 183
The Veterans Affairs health system 186
The Indian Health Service 188
The Black Lung Program 188
Mixing Medicare with Workers’ Comp or No-Fault or Liability Insurance 189
When you first make a claim 190
If the claim isn’t settled promptly 190
When the claim has been settled 191
Part 3: Making Smart Choices among Medicare’s Many Options 193
Chapter 9: Making Sense of Medicare’s Many Options 195
Seeing the Big Picture: Your Starting Point to Navigating the Medicare Maze 196
Understanding the consequences of your choice of system 196
Weighing the two systems 199
Recognizing when you may not have a choice 202
Being on your guard against “auto-enrollment” 203
Digging into the Details of Traditional Medicare versus Medicare Advantage 205
Opting for traditional Medicare 205
Looking at Medicare Advantage plans 207
Checking out three other types of Medicare health plans 211
Discovering How Medigap Policies Differ from Medicare Advantage Plans 212
Chapter 10: Choosing Wisely If You Go with Traditional Medicare 215
Understanding the Need to Compare Part D Plans Carefully 216
Knowing what not to do 216
Defining “the best plan” 217
Recognizing that comparing plans is worth the effort 218
Seeing how comparing plans can save big bucks 219
Getting organized with two crucial lists 221
Picking the Part D Plan That’s Best for You 223
Assessing the Plan Finder’s reliability 224
Using the Medicare Plan Finder to discover options available to you 225
Drilling down to important bits of info when comparing Part D plans 228
Choosing the Medigap Supplemental Policy That’s Best for You 233
Choosing a Medigap policy 233
Buying a Medigap policy at the right time 235
Buying Medigap if you’re under 65 237
Suspending a Medigap policy 239
Chapter 11: Making Smart Choices If You Opt for Medicare Advantage 241
Comparing Medicare Advantage Plans 242
Comparing plans’ medical benefits 243
Adding prescription drug coverage 247
Choosing the Medicare Advantage Plan That’s Right for You 250
Figuring out which providers accept the plans you’re considering 250
Enrolling in a Medicare Advantage plan 251
Taking action if you change your mind 252
Chapter 12: Getting Help in Making Medicare Choices 255
One on One: Getting Personal Help on Medicare Issues 256
Asking family and friends 256
Contacting State Health Insurance Assistance Programs 257
Calling Medicare’s help line 258
Seeking advice from other sources 260
Buyer Beware! Avoiding Scams and Hard-Sell Marketing 261
Steering clear of outright scams 262
Resisting hard-sell marketing tactics 265
Part 4: Navigating Medicare from the Inside 269
Chapter 13: Starting Out as a New Medicare Beneficiary 271
Playing Your Cards Right 272
Understanding when to use each card 272
Replacing your cards 275
Beyond the Cards: Checking Out the Extent and Limits of Your Coverage 275
Managing Premiums 277
Discovering different ways to pay Medicare premiums 277
Knowing what can happen when you don’t pay your premiums on time 281
Keeping Track of Your Expenses 284
Understanding Medicare Summary Notices 284
Maintaining hard-copy records you can rely on 287
Tracking information online 288
Dealing with Doctors 288
Finding doctors who accept Medicare patients 289
Understanding what doctors can charge you 289
Filling Prescriptions for the First Time with a Part D Plan 292
When does my coverage begin? 292
Which kind of pharmacy can I use? 293
What happens if I go to an out-of-network pharmacy? 295
How do I prove I have Part D coverage? 296
How can I ensure I get my meds? 297
Chapter 14: Getting the Inside Scoop on Using Certain Medicare Benefits 301
Taking a Closer Look at Part A 302
Understanding hospital benefit periods 302
Taking note of the three-day rule 304
Defining observation status 305
Being aware of the improvement standard 308
Fighting premature hospital discharge 309
Proceeding if the hospital makes a mistake 310
Knowing your rights in a skilled nursing facility 310
Zooming In on Part B 314
Checking on whether Medicare will cover your treatment 314
Receiving a notice saying that Medicare may not pay 315
Determining whether you can find out a service’s cost in advance 317
Maximizing your chances for coverage 318
Recognizing your right to second opinions 319
Filing a claim directly to Medicare 320
Delving into Part D 321
Understanding how a plan may restrict your drug coverage 322
Grappling with the tier system of co-pays 324
Navigating the doughnut hole 327
Using Part D to get the shingles vaccine 328
Taking advantage of free Medication Therapy Management benefits 329
Chapter 15: Changing Your Medicare and Medigap Coverage 331
Switching Coverage during Open Enrollment or Disenrollment 332
The open enrollment period 332
The disenrollment period 333
Taking Advantage of Special Enrollment Periods 334
Recognizing when you can use SEPs to change plans 335
Making sure your records and prescriptions are transferred 339
Dropping a Plan (Or Being Dropped) 341
Leaving a plan on your own 341
Getting the boot from your plan 342
Deciding Whether to Stay or Switch to Another Plan for Next Year 344
Reading your Annual Notice of Change to understand plan alterations 344
Comparing plans (yes, all over again!) 346
Looking at extra factors influencing your decision 347
Changing to Another Medigap Policy 348
Knowing the consequences of switching Medigap policies 349
Exploring a change of Medigap coverage 350
Exercising your right to a 30-day free look 350
Chapter 16: Knowing Your Rights 351
Understanding Your Right to Accurate Information 351
Knowing whom to call 352
Seeking a second opinion 353
Asking for an Investigation 354
Requesting equitable relief 354
Contacting an ombudsman 355
Reaching out to your Quality Improvement Organization 355
Getting ahold of your plan 356
Filing a grievance 356
Taking Steps toward an Appeal 357
Obtaining a formal denial 358
Requesting a coverage determination 358
Having a game plan in mind before you move ahead with an appeal 360
Filing a Formal Appeal 361
Walking through the five levels of appeal 361
Getting help in making an appeal 366
Part 5: The Part of Tens 367
Chapter 17: Top Ten Medicare Mistakes 369
Thinking You Must Reach Full Retirement Age before Signing Up 370
Assuming You Don’t Qualify If You Haven’t Worked Long Enough 370
Failing to Enroll in Part B When You Should 371
Believing You Don’t Need Part B If You Have Retiree or COBRA Coverage 371
Not Signing Up for Part D Because You Don’t Use Prescription Drugs 372
Picking a Part D Drug Plan for the Wrong Reasons 372
Misunderstanding Enrollment Periods 373
Being Too Late to Buy Medigap with Full Protections 373
Failing to Read Your Annual Notice of Change 374
Not Realizing You May Qualify for Help to Lower Your Costs 375
Chapter 18: Ten Ways to Stay Healthier beyond Age 65 377
Taking Action to Avoid Falls 377
Exercising Regularly 379
Quitting Smoking 379
Eating Healthfully 380
Cutting Out Soft Drinks and Extra Sugar 381
Keeping an Eye on Prescription Drugs 381
Continuing to Work or Stay Active 382
Staying Connected and Engaged 382
Keeping Your Brain in Shape 383
Addressing Tough Choices before They’re Necessary 383
Part 6: Appendixes 385
Appendix A: Sources of Help and Information 387
Government Help Lines and Websites 387
The Centers for Medicare & Medicaid Services 388
The Social Security Administration 388
State Health Insurance Assistance Programs 389
The Eldercare Locator 394
Independent Sources of Direct Help 394
The Medicare Rights Center 394
The National Alliance for Hispanic Health 395
The National Asian Pacific Center on Aging 395
Resources for Saving Money 396
Consumer Information and Advocacy Organizations 397
Sources for Updates on Medicare 398
Appendix B: Glossary 399
Index 405
