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Medicare for Busy People: Part 1

Medicare: the word promises much-needed relief from medical bills… if you can only survive the paperwork. Yes, while Medicare provides more than 43 million Americans with health care assistance, the numerous benefits it offers can be a bewildering process to sort through. With this in mind, we’d like to shed some light on how you or your loved ones can benefit from this program without (hopefully) the need for anxiety medication.

• Medicare Basics
• Before You Enroll
• Picking a Plan
• Medicare Part A
• Medicare Part B
• Medicare Part C
• Other Resources
• E-mail this Information to A Friend
• Other Topics in the Consumer Focus Archive
• Medicare for Busy People: Part 2, Medicare Part D

Posted: November 7, 2008

Medicare Basics

Like most types of health insurance, Medicare covers a portion of the cost for medications and health services. Most parts of Medicare require monthly premiums, in addition to co-pays and other service costs.

If you are researching Medicare for yourself or for a loved one, don’t forget to include it as part of a group of lifestyle decisions, including diet, exercise, long-term care insurance, and legal considerations such as power of attorney,a living will (also known as an advanced directive), and a will.

You are eligible for Medicare if:

• You are eligible for Social Security (i.e. you have worked for more than 10 years in the United States) and are over 65 years old OR
• You suffer from a permanent disabling illness, such as end-stage renal disease (liver failure) or ALS (Lou Gehrig's disease). In these cases, you need to file for Social Security Disability Insurance.

If you are over 65 and are receiving Social Security, you are automatically registered for Medicare, and will receive a Medicare card in the mail about 3 months before your 65th birthday. You will be enrolled in Medicare Parts A and B automatically, but you may elect to turn down Part B if you don’t want to pay the monthly premiums for coverage of doctor visits and other services outside a hospital.

However, if you do not sign up for Part B when you initially enter Medicare, you will pay a stiff penalty every year for the rest of your life (really!) if you sign up for Part B later on. For this reason, many people choose Part B along with Part A (also known as the Original Medicare Plan).

You currently cannot sign up for Medicare online. To enroll, contact Social Security at (800) 772-1213, or visit CMS.gov's Contacts Database for Medicaid centers in your area.

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Before You Enroll

Keep these basic questions in mind as you begin:

• When does it start? Medicare plans start the first day of the month after you are registered, so you’ll want to enroll as close to the beginning of the month as possible to give Medicare time to process your information.
• Already covered? If you already have a form of health insurance, you can still be covered by Medicare, often with additional benefits as a result. Contact Medicare and let them know about your plan so you can discuss "coordination of benefits."
• Medicaid - If you have limited income you may be eligible for Supplemental Social Security Benefits or Medicaid. Contact Social Security at 800-772-1213 or visit Social Security's website.

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Picking a Plan

OK. Take a deep breath. Here are the different parts:

Part A: Hospital Insurance

Medicare Part A covers hospital stay costs. Part A also covers hospice care, and may cover home health care and some medical supplies such as wheelchairs.

The good news is that if you are eligible to receive Social Security, you get Part A for free (no monthly premiums). If you’re not eligible for Social Security, you may still be able to get Part A, but you may have to pay a monthly premium.

Part B: Medical Insurance and Equipment

Part B is for medical services that take place outside of a hospital stay. This includes doctor visits, outpatient services (screenings, blood work, mental health, etc.), ambulance services, medical equipment and some home health services. It does not cover routine dental or vision care, elective surgery, or vaccinations.

Part B is optional. Compare the benefits that Part B provides with the benefits available from any other policy you can carry into retirement. Remember that if you want to pick up Part B later, the premiums will be higher.

Part C: Medicare Advantage Plans (MAPs)

Part C tries to lower your costs by offering you all your health services from a single providing organization. They are run by private companies but are still a part of Medicare. Part C encourages preventative care and individual consults for patients. If you take care of yourself and listen to your doctor, the hoped for result is that you will be healthier and there will be lower costs for everyone involved. You might even see reductions in your premiums.

Many Advantage Plans have networks of approved providers. See which doctors and hospitals on the plan are in your area. Online enrollment for Part C begins Nov. 15, 2008.

To see if Part C can save you money, compare it to other plans by doing a personalized plan search or a general plan search.

There are other benefits – some Part C plans offer dental and vision care or prescription drug coverage. You can always add your own prescription drug plan as well (see Part D in our next article).

You must have both Parts A and B to enroll in Part C. Call 800-633-4227 (TTY 877-486-2048) or visit Medicare’s website for more information.

Next issue: Making “Medicare Part D: Prescription Drugs” easier to swallow and Don’t Despair: How to Appeal if you are Denied Coverage.

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Other Resources

This is just a brief overview. For more information, check out these resources:

Read these publications online or order them from FCIC:

• Medicare Basics: A Guide for Families and Friends of People with Medicare
• Resources for Medicare Beneficiaries: Navigating the Coverage Gap
• Worksheet for Comparing Medicare Health Plans

Websites*

• Medicare
• Official Government Medicare Handbook (2009)

* Names of resources and organizations included in this online article are provided as examples only, and their inclusion does not mean that they are endorsed by the Federal Citizen Information Center or any other Government agency. Also, if a particular resource or organization is not mentioned, this does not mean or imply that it is unsatisfactory.

*If you click on these links, you are leaving FCIC's website. Please bookmark us before you leave so you can return easily. FCIC is not responsible for the content of these websites.

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For more information on other popular consumer issues check out FCIC's Consumer Focus Archive.

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