Details

Medicare For Dummies

4. Aufl.

von: Patricia Barry
20,99 €
Verlag:	Wiley
Format:	EPUB
Veröffentl.:	08.10.2020
ISBN/EAN:	9781119689997
Sprache:	englisch
Anzahl Seiten:	448

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Beschreibungen

Titelbeschreibung

Medicare made simple Medicare brings valuable benefits to more than 58 million people and growing, but most of us don’t even know the basics of how Medicare can work best for us. That’s where Medicare For Dummies, 4th Edition comes in, explaining how this complex system functions and helping you confidently navigate your way through the maze to get the most out of your coverage. This indispensable resource untangles Medicare in friendly, straightforward language. Step by step, you’ll learn when and how to enroll, ways to avoid costly mistakes, and how to find the plan that brings the most benefit to you and your family. <ul> <li>Reduce out-of-pocket expenses </li> <li>Know your rights and protections </li> <li>Choose the best policy for you </li> </ul> Using this reassuring and comprehensive guide, you’ll be able to get the answers to all your questions, find guidance on how to act—and then get on with getting the benefits you need.

Inhaltsverzeichnis

Introduction 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

Autorenportrait

Patricia Barry is a recognized authority on Medicare who has written extensively about the program for consumers. For nearly two decades, as a senior editor of AARP's publications, she wrote hundreds of articles on Medicare and served as the online "Ask Ms. Medicare" columnist, answering thousands of questions sent by Medicare beneficiaries across the nation.

Back cover copy

<ul> <li>Get tips on navigating the Medicare maze</li> <li>Determine the best time to enroll and how</li> <li>Save money by avoiding costly mistakes</li> </ul> Medicare made simple Despite its importance in our lives, few of us understand even the basics of how Medicare works. That's where Medicare For Dummies comes in: This essential guide demystifies the often-complex system in a friendly, straightforward style and explains everything from when and how to enroll and finding the plan that's best for you to avoiding costly mistakes. Whatever your question, this is your reassuring resource, allowing you to stop worrying and know that you're getting the most out of your coverage. Inside... <ul> <li>Know what Medicare covers</li> <li>Understand how to qualify</li> <li>Enroll at the right time</li> <li>Maximize your coverage</li> <li>Evaluate Medigap options</li> <li>Know your rights</li> <li>Change your plan</li> <li>Avoid common mistakes</li> </ul>