Medicare Leaves Me Scratching My Head

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By Kathleen Ganster

Medicare—the very word makes some people break out in a sweat. Medicare is the health insurance provided for senior citizens by the Federal Government. But there is Plan A, Plan B, Plan C and do you need Plan D? And what on earth is Medigap or Medicare Advantage?  What is up with all of these plans?

The more I researched options available under Medicare, the more confused I became and soon found myself near tears.

And I was only researching for an article, not making the important decision about my own healthcare!

As I dug through the resources, I found some that I shoved to the side (well, actually threw in the trash), others that actually helped me figure out what was what. I also talked to a few folks who have navigated the system so that I could offer you their tips as well.

Hopefully, I can explain various components of Medicare for others facing the choices and provide resources that actually helped, not befuddled me.

Please keep in mind that I can’t possibly translate every fact regarding the Medicare program in one article. Also keep in mind that health care is constantly in the news and open to change. This article is to serve as a basic starting point and guide. 

When to choose your Medicare coverage

Before you even get started on the whole Medicare process, make sure you start researching early. Most of us are eligible to start receiving these benefits at age 65. When you sign-up to receive Social Security benefits, you are essentially also registering for Medicare and will automatically start getting Part A and Part B on the first day of the month that you turn 65. That’s why you want to take care of the process BEFORE you turn 65. Three months before you turn 65, you should contact Social Security even if you are still employed.

If you are still working at 65, as many of us are these days, you can still sign-up for Medicare by contacting 1-800-877-1213 or www.medicare.gov/MedicareElibigility.

You should also make sure that you take care of choosing your healthcare when you turn 65, or when you retire or you may have to wait until Open Enrollment which is October 15 to December 7, 2012.

Also be aware that your benefits may change if you move—even within the state.

Medicare Plan A

Medicare Plan A and B are the components of healthcare for those 65 and older provided by the Federal Government. Almost everyone age 65 and older is eligible for Medicare Plan A. Some citizens are actually eligible earlier, for example, if you are on disability.  But the majority of us are eligible at 65 and most of us receive these benefits for free.

Medicare Plan A is often called the “hospital insurance” – inpatient hospital or skilled nursing costs, hospice services and home health care services. Now while you may have this coverage for free, you may still have to pay for copayments, deductibles and coinsurance.

Again, most people will not have to pay for this coverage.

Plan B 

Unlike Plan A, you will have to pay some fee for this part of your coverage, but the fees can be automatically deducted from your Social Security benefits. If you or your spouse are still employed, your current health care plan may be a better plan – find out from your employer. If you chose a supplemental health care program, that program may also cover your Plan B services. Ask your healthcare provider. 

Everyone does need to be enrolled in Plan B which covers your outpatient services. These are often things that are considered preventative medical services as well such as routine doctor’s visits, lab work, tests, etc. You will want to ask your doctors if the accept Medicare. Not all doctors do – ASK.

Plan C – Medicare Advantage Plan

We all know that health care also includes dental and eye care. Adding a supplemental insurance policy can save you money in the long run. There are numerous providers for Plan C and it combines Plan A, Plan B and often Plan D.

Plan D – Prescription Drug Plan

Many supplemental health care programs include some sort of prescription drug coverage. You may also just need to add a Plan D (that you pay for yourself) to a health care program that you may receive as part of your retirement benefits. This is also called a Medigap program.

It is important to note, if you have a Medicare Advantage Plan you don’t need a Medigap policy.

With all of the above plans, you may also have to pay a co-pay and have a deductable. Like everything else, ask questions to see what those costs may be.

Valuable Resources

Joe Bertucci and his wife, Pat, relied on the human resources personnel at his former company when he planned on retiring.

“They were extremely helpful and explained everything. I found out that I had to apply for Plan B (they were already on Plan A from when they had turned 65), before I could be eligible for my company’s retirement health benefits,” he said.

Fortunately, Joe had planned far enough in advance that everything was lined up before his retirement, but Pat did make a run to the Butler County Social Security Office – the couple lives in Cranberry – to make sure the process was complete.

“They gave us papers that we could use in case we needed something before our ‘official’ cards came in the mail,” said Bertucci.

Watching the videos on YouTube produced by http://www.youtube.com/user/medicaremadeclear gave me a starting place.

Visiting the website www.medicare.gov produced by the federal government helped me further research options and answered a lot of my questions.

A booklet “Medicare & You 2012” produced by the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services and available by calling 1-800-783-7067 was very valuable and presented information in a very easy-to-read fashion. I was able to leaf through the booklet to flush out information I obtained from other sources including friends.

There are also services offered through your county offices. In Allegheny County, the Agency on Aging can provide various resources at www.alleghenycounty.us or 1-800-344-4319. They do not answer questions, but have some publications online.

The APPRISE line does have counselors that can answer questions but you may have to leave a message for them to call you back. Their number is 1-800-344-4319. It took them 24 hours to call me back, but they were very helpful and will answer your questions.

Summary

Navigating the Medicare healthcare system can be tricky. Try not to get overwhelmed – like I did – and seek out additional help to explain the various parts and services covered.  The number one tip that I would offer is ASK QUESTIONS. Don’t be ashamed to ask questions and if necessary, get a friend or loved one involved to be a second set of ears and eyes. This is your healthcare we are talking about – nothing is more important.

 

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