Medicare For Dummies

Title Page
Copyright Page
Table of Contents
Introduction
	About This Book
	Foolish Assumptions
	Icons Used in This Book
	Beyond the Book
	Where to Go from Here
Part 1 Getting Started with Medicare
	Chapter 1 The Nuts and Bolts of Medicare: What It Is and How It Works
		Addressing Some Upfront Questions
		Coming to Terms with the ABCs (and D) of Medicare
			Part A
			Part B
			Part C
			Part D
		Recognizing That You Have Choices and Must Make Timely Decisions
	Chapter 2 Spelling Out What Medicare Covers (A Lot, but Not Everything)
		Understanding What Part A and Part B Cover
			Necessary medical care
			Preventive care
			Specialized care in certain circumstances
				Care in a skilled nursing facility
				Home healthcare services
				Hospice care
				Palliative care
				End-of-life care counseling
				Pregnancy and childbirth
			Medical supplies and equipment
		Knowing What Part D Covers
			Making sense of drug coverage that can vary throughout the year
			Finding out about formularies
				Laying out the drugs Part D plans must cover
				Recognizing the drugs Medicare doesn’t pay for
			Determining when drugs are covered by Part A, Part B, or Part D
		The Gaps: Discovering What Medicare Doesn’t Cover
			Routine hearing, vision, dental, and foot care
			Home safety items
			Nursing home care
			Medical services abroad
			Services that may be nice but aren’t necessary
		Distinguishing When Coverage Comes with Limits
			Limits on hospital stays
				If you’re enrolled in original Medicare
				If you’re enrolled in a Medicare Advantage health plan
			Limits on skilled nursing facility stays
			Limits on mental health benefits
				Outpatient psychiatric services
				Psychiatric care in a hospital
				Mental health benefits in Medicare Advantage plans
			Limits on therapy services
	Chapter 3 Understanding What You Pay Toward Your Costs in Medicare
		Boning Up on Premiums, Deductibles, and Co-payments
			Part A costs
				Premiums
				Deductible
				Co-payments (hospital and skilled nursing facility)
				Co-payments (home healthcare and hospice care)
				Out-of-pocket limits
			Part B costs
				Premiums
				Deductible and co-payments
				Out-of-pocket limits
			Part D costs
				Premiums
				Deductible
				Co-payments
				Out-of-pocket limits
			Medicare Advantage costs
				Premiums
				Deductible
				Co-payments
				Out-of-pocket limits
		Paying Higher-Income Premiums
			Understanding who’s liable for the surcharges
				Determining when you may be liable, even if your income isn’t high
				Recognizing that you may be liable for a Part D surcharge, even without a Part D plan
			Figuring out what the surcharges cost you
			Getting the surcharges waived
				Knowing what qualifies as a life-changing event
				Verifying whether other situations qualify for a waiver
		Paying Different Premiums than Other People in Certain Years
		Paying Medicare Taxes While Receiving Medicare Benefits
	Chapter 4 Reducing Your Out-of-Pocket Expenses in Medicare
		Purchasing Medigap Insurance
			Examining Medigap policies
				If you live in Massachusetts, Minnesota, or Wisconsin
				If you live in a state where “innovative” Medigap policies are sold
				If you have a Medigap policy that’s no longer sold
			Choosing and buying a Medigap policy
		Qualifying for Help from Your State
			Medicaid
			Medicaid medical spend-down programs
			Medicare Savings Programs
			PACE plans
			State Pharmacy Assistance Programs
		Examining Whether Extra Help Can Lower Your Drug Costs
			Qualifying for Extra Help
			Applying for Extra Help
				How can I obtain the form?
				What if English isn’t my first language?
				What counts as income?
				What counts as assets?
				What counts as “single” and “married” for income purposes?
				What if I’m supporting other family members?
				Who can help me apply?
				How do I complete the application process?
				What happens after I apply?
				What if Social Security turns me down?
				If I qualify, how long does my Extra Help last?
				How do I know whether my Extra Help will continue?
			Choosing a drug plan with Extra Help
				Understanding the automatic enrollment system
				Clarifying zero premiums
		Considering Other Ways to Cut Costs
			Taking income tax deductions for Medicare costs
			Lowering drug costs without Extra Help
				Taking a hard look at your meds
				Switching to less-expensive drugs
				Switching to a less-expensive Part D drug plan
				Using mail order or preferred pharmacies
				Finding free or low-cost prescription drugs
Part 2 The Hows and Whens of Medicare
	Chapter 5 Qualifying for Medicare
		Hitting the Milestone of Age 65
			Debunking some qualification myths
			Meeting the requirements for Parts A, B, and D
				Part A
				Part B
				Part D
			Qualifying for Part A on your own work record
			Being eligible for Part A on someone else’s work record
				Your current/former spouse has enough credits
				Neither you nor your spouse has 40 work credits
				You’re the foreign spouse of a U.S. citizen or legal resident
				You’re in a same-sex marriage
				You are unmarried but live in a domestic partnership
		Qualifying for Medicare under Age 65 on the Basis of Disability
			Receiving disability payments
				How does the 24-month waiting period work?
				How long does Medicare coverage last?
				Does railroad retirement disability work in the same way?
			Suffering from permanent kidney failure (ESRD)
			Living with Lou Gehrig’s disease (ALS)
		Falling through the Cracks: Healthcare Options if You Can’t Get Medicare Yet
			Nice work if you can get it: Landing a job with benefits
			Paying for COBRA temporary insurance
			Purchasing individual insurance through the online Marketplace
			Buying health insurance outside of the Obamacare Marketplace
			Getting healthcare without insurance
	Chapter 6 Enrolling in Medicare at the Right Time for You
		At a Glance: Surveying Situations That Affect Enrollment Timing
		Understanding Your Initial Enrollment Period
			Using your IEP at age 65
			Taking advantage of your IEP when you have disabilities
		Delaying Part B if You’ll Qualify for a Special Enrollment Period Later
			Being able to delay Part B without penalty
				“For whom you or your spouse still actively work”
				“That employer has 20 or more employees”
				“Until this employment or the health coverage ends (whichever comes first)”
			Knowing what to do about Part A if you delay Part B
			Heeding a special warning if you have a health savings account at work
			Using the special enrollment period
		Enrolling in Other Specific Situations
			You’re a legal permanent resident
			You live outside the United States
				Working overseas
				Not qualifying for premium-free Part A
				Signing up for Part D drug coverage
			You’re in a domestic partnership
			You’re incarcerated
		Deciding Whether and When to Sign Up for Part D Drug Coverage
			Assessing drug coverage you have from elsewhere
				Coverage that’s creditable
				Coverage that you need to check out
				Coverage that isn’t creditable
				Coverage that isn’t coverage
			Debating whether you need Part D if you don’t take medications
			Figuring the best time to enroll in Part D
		Understanding the Consequences of Not Signing Up at the Right Time
			Missing your deadline for Part B
				Going without health coverage
				Paying more for Part B services than you need to
			Passing your deadline for Part A
			Neglecting your deadline for Part D
				Being without drug coverage
				Understanding how Part D late penalties are calculated
			Figuring out whether you can get a late penalty revoked
				If you think the late penalty is a mistake
				If you were given wrong information
	Chapter 7 Discovering How to Sign Up for Medicare
		Being Automatically Enrolled in Medicare Parts A and B
		Sign Me Up! Applying for Medicare Parts A and B
			Signing up from inside the United States
				One . . . two . . . three ways to sign up
				If you live in different places for parts of the year
				If English isn’t your first language
			Enrolling while you’re living abroad
				Applying if you qualify for full Medicare benefits
				Applying if you aren’t fully insured for Medicare
				Contacting Social Security from outside the United States
		Opting Out of or Disenrolling from Part A or Part B
			Declining Part A
			Opting out of Part B
				Knowing when to turn down Part B if you’re 65 or older
				Understanding when to turn down Part B if you’re under 65
				Recognizing when turning down Part B at any age is risky
			Disenrolling from Part B
		Knowing When Your Coverage Begins
			When you sign up during the first three months of your IEP
			When you sign up during IEP months four through seven
			When you are awarded Medicare coverage retroactively
		Transitioning from Obamacare to Medicare
			Figuring out whether you need to make the switch
				“If I’m happy with the Marketplace plan I currently have, must I switch to Medicare?”
				“My employer bought my Marketplace insurance through SHOP. If I keep working after 65, must I enroll in Medicare?”
				“I don’t have enough work credits for premium-free Part A. Can I stay on my Marketplace plan until I’ve earned enough?”
				“I’m in Part A but missed my deadline for Part B sign-up. Can I enroll in a Marketplace plan until Part B coverage kicks in?”
				“If I enroll in Medicare, I’ll have to pay high Part B premiums due to high income. Can I stay on my cheaper Marketplace plan? ”
			Knowing how and when to switch from Marketplace to Medicare
				“I have a Marketplace plan on my own. How do I switch from that plan to Medicare? ”
				“My family is on a Marketplace plan, but I’ll be eligible for Medicare soon. Can my family stay on the plan after I leave?”
				“My Marketplace plan provides dental coverage. Does Medicare do so?”
				“Can I sign up for any Medicare plans through the online Marketplace?”
				“If I need help in cancelling my Marketplace plan or starting Medicare coverage, whom should I call?”
	Chapter 8 Understanding How Medicare Fits In with Other Health Insurance
		Understanding Medicare’s Coordination of Benefits System
			Helping Medicare help you: Filling out your initial enrollment questionnaire
			Keeping Medicare informed if your coverage changes
		Seeing How Medicare Works with an Employer’s Health Insurance Plan
			Working with insurance from a current employer
				Is my employer insurance primary or secondary to Medicare?
				Do I get the same health benefits at work as I get now?
				How else does having an employer plan affect me?
				Can I choose to drop my employer plan and have just Medicare?
				How does my ESRD-qualified Medicare work with my employer coverage?
			Having insurance from a former employer
				Are retiree/COBRA benefits primary or secondary to Medicare?
				How do my retiree benefits work with Medicare?
				Can I choose to drop my retiree benefits and have just Medicare?
				How does COBRA work with Medicare?
				What if I have prescription drug coverage from my retiree or COBRA plan?
		Figuring Out How Other Federal Health Benefits Fit In with Medicare
			The Federal Employees Health Benefits Program
				What if I become eligible for Medicare while I’m still working?
				How does Medicare fit in with my plan after I retire?
				How does my FEHB coverage work if I have Medicare due to disability or ESRD?
			TRICARE and TRICARE For Life
				What if I become eligible for Medicare while I am (or my spouse is) still on active duty or I have coverage from another job?
				What if I become eligible for Medicare based on disability?
				How does Medicare fit in with my TRICARE For Life benefits?
			The Veterans Affairs health system
			The Indian Health Service
			The Black Lung Program
		Mixing Medicare with Workers’ Comp or No-Fault or Liability Insurance
			When you first make a claim
			If the claim isn’t settled promptly
			When the claim has been settled
Part 3 Making Smart Choices among Medicare’s Many Options
	Chapter 9 Making Sense of Medicare’s Many Options
		Seeing the Big Picture: Your Starting Point to Navigating the Medicare Maze
			Understanding the consequences of your choice of system
				Considerations for choosing one system over the other
				An important limitation on your choice
			Weighing the two systems
				Overall costs
				Premium costs
				Co-pay costs
				Cost and benefit stability
				Care stability
				Provider choice and care coordination
				Extra benefits
				Geographical area
				Quality measures
			Recognizing when you may not have a choice
			Being on your guard against “default enrollment”
		Digging into the Details of Original Medicare versus Medicare Advantage
			Opting for original Medicare
			Looking at Medicare Advantage plans
				Health maintenance organizations (HMOs)
				Preferred provider organizations (PPOs)
				Private Fee-for-Service (PFFS) plans
				Special Needs Plans (SNPs)
				Medical Savings Account (MSA) plans
			Checking out three other types of Medicare health plans
		Discovering How Medigap Policies Differ from Medicare Advantage Plans
	Chapter 10 Choosing Wisely If You Go with Original Medicare
		Understanding the Need to Compare Part D Plans Carefully
			Knowing what not to do
			Defining “the best plan”
			Recognizing that comparing plans is worth the effort
			Seeing how comparing plans can save big bucks
			Getting organized with two crucial lists
				Creating an accurate list of your meds
				Drawing up a list of your plan preferences
		Picking the Part D Plan That’s Best for You
			Assessing the Plan Finder’s reliability
			Using the Medicare Plan Finder to discover options available to you
				Walking through a few steps
				Homing in on handy features of the “plan results” page
			Drilling down to important bits of info when comparing Part D plans
				Finding out your month-by-month costs
				Lowering your drug costs
				Examining retail pharmacy choices
		Choosing the Medigap Supplemental Policy That’s Best for You
			Choosing a Medigap policy
			Buying a Medigap policy at the right time
			Buying Medigap if you’re under 65
			Suspending a Medigap policy
	Chapter 11 Making Smart Choices If You Opt for Medicare Advantage
		Comparing Medicare Advantage Plans
			Comparing plans’ benefits
				Moving through the Plan Finder
				Digging for plan details
				Walking through an example
			Adding prescription drug coverage
				Entering your drugs into the Plan Finder
				Checking out an example
		Choosing the Medicare Advantage Plan That’s Right for You
			Figuring out which providers accept the plans you’re considering
			Enrolling in a Medicare Advantage plan
			Taking action if you change your mind
	Chapter 12 Getting Help in Making Medicare Choices
		One on One: Getting Personal Help on Medicare Issues
			Asking family and friends
			Contacting State Health Insurance Assistance Programs
			Calling Medicare’s help line
			Seeking advice from other sources
				Doctors and pharmacists
				Insurance agents
				Seminars and information sessions
				Businesses dedicated to Medicare help
		Buyer Beware! Avoiding Scams and Hard-Sell Marketing
			Steering clear of outright scams
				Watching out for red flags
				Surveying some common scams targeting seniors
				Reporting a scam
				Taking steps if you’re ripped off
			Resisting hard-sell marketing tactics
				Knowing which marketing methods are (and aren’t) allowed
				Thinking and checking before you sign
				Taking action if you’re misled into joining a plan
Part 4 Navigating Medicare from the Inside
	Chapter 13 Starting Out as a New Medicare Beneficiary
		Playing Your Cards Right
			Understanding when to use each card
				Your Medicare ID card
				Your Medicaid ID card
				Your Medicare Advantage plan membership card
				Your stand-alone Part D prescription plan membership card
				Your Medigap supplemental insurance card
			Replacing your cards
		Beyond the Cards: Checking Out the Extent and Limits of Your Coverage
		Managing Premiums
			Discovering different ways to pay Medicare premiums
				Having Part B premiums deducted from benefit checks
				Receiving a bill for Part A and Part B premiums
				Transitioning from direct billing to Social Security deductions
				Paying premiums in a Medicare drug or health plan
			Knowing what can happen when you don’t pay your premiums on time
				When you’re in original Medicare
				When you’re enrolled in a Medicare drug or health plan
				The consequences of disenrollment
		Keeping Track of Your Expenses
			Understanding Medicare Summary Notices
			Maintaining hard-copy records you can rely on
			Tracking information online
		Dealing with Doctors
			Finding doctors who accept Medicare patients
			Understanding what doctors can charge you
				Doctors who opt out of Medicare
				Doctors who provide concierge or boutique services
		Filling Prescriptions for the First Time with a Part D Plan
			When does my coverage begin?
			Which kind of pharmacy can I use?
				Retail pharmacies
				Mail-order pharmacies
				Specialty pharmacies
				Long-term-care pharmacies
			What happens if I go to an out-of-network pharmacy?
			How do I prove I have Part D coverage?
			How can I ensure I get my meds?
				If the pharmacist can’t confirm your enrollment in a plan
				If the pharmacist says the plan won’t pay for one of your meds
				If the pharmacist charges you more than you think is correct
				If the pharmacist says your doctor isn’t an approved Medicare prescriber
	Chapter 14 Getting the Inside Scoop on Using Certain Medicare Benefits
		Taking a Closer Look at Part A
			Understanding hospital benefit periods
				Hospital coverage in original Medicare
				Skilled nursing care in original Medicare
				Hospital and SNF coverage in Medicare Advantage plans
			Taking note of the three-day rule
			Defining observation status
				Understanding the consequences of being in observation status
				Protecting yourself against big bills
			Being aware of the improvement standard
			Fighting premature hospital discharge
			Proceeding if the hospital makes a mistake
			Knowing your rights in a skilled nursing facility
				Leaving the SNF for short periods
				Moving out of SNF care (and later returning)
				Seeing the doctor of your choice
				Filing a claim even if you’re told Medicare won’t pay
		Zooming In on Part B
			Checking on whether Medicare will cover your treatment
			Receiving a notice saying that Medicare may not pay
				The options on an ABN
				A word about ambulance services
			Determining whether you can find out a service’s cost in advance
			Maximizing your chances for coverage
			Recognizing your right to second opinions
			Filing a claim directly to Medicare
				If the doctor fails to file a claim
				If you need Medicare to deny a claim
		Delving into Part D
			Understanding how a plan may restrict your drug coverage
				Defining prior authorization, quantity limits, and step therapy
				Requesting an exception with your doctor’s help
				Obtaining a prescription from the right doctor
			Grappling with the tier system of co-pays
				What are pricing tiers?
				How can you find out your plan’s pricing tiers?
				What if your drug is suddenly switched to a higher price tier?
			Navigating the doughnut hole
			Using Part D to get the shingles vaccine
			Taking advantage of free Medication Therapy Management benefits
	Chapter 15 Changing Your Medicare and Medigap Coverage
		Switching Coverage during Open Enrollment
			The open enrollment period
			The Medicare Advantage open enrollment period
		Taking Advantage of Special Enrollment Periods
			Recognizing when you can use SEPs to change plans
				You move permanently outside your plan’s service area
				You move into or leave a nursing home or other long-term-care facility
				You’re in a Medicare Advantage plan and want to change to original Medicare
				You dropped a Medigap policy to enroll in a Medicare Advantage plan for the first time
				You want to switch to a high-quality five-star plan
				Your plan withdraws service from your area, doesn’t renew its contract with Medicare, or closes down
				You lose drug coverage from an employer or union, COBRA, or retiree benefits
				You lose Medicaid or Medicare Savings Program eligibility
				A plan violates its contract with you
				You were misled into joining a Medicare Advantage plan
				A federal employee made a mistake when processing your enrollment or disenrollment in a plan
			Making sure your records and prescriptions are transferred
		Dropping a Plan (or Being Dropped)
			Leaving a plan on your own
			Getting the boot from your plan
		Deciding Whether to Stay or Switch to Another Plan for Next Year
			Reading your Annual Notice of Change to understand plan alterations
			Comparing plans (yes, all over again!)
			Looking at extra factors influencing your decision
				Carrying over exceptions from your current plan
				Switching to a Medicare Advantage plan
		Changing to Another Medigap Policy
			Knowing the consequences of switching Medigap policies
			Exploring a change of Medigap coverage
			Exercising your right to a 30-day free look
	Chapter 16 Knowing Your Rights
		Understanding Your Right to Accurate Information
			Knowing whom to call
				Social Security Administration
				Centers for Medicare & Medicaid Services
			Seeking a second opinion
		Asking for an Investigation
			Requesting equitable relief
			Contacting an ombudsman
			Reaching out regarding quality of service
			Getting ahold of your plan
			Filing a grievance
		Taking Steps toward an Appeal
			Obtaining a formal denial
			Requesting a coverage determination
			Having a game plan in mind before you move ahead with an appeal
		Filing a Formal Appeal
			Walking through the five levels of appeal
				Level 1: Redetermination by Medicare or your plan
				Level 2: Reconsideration by an independent panel
				Level 3: Hearing with an administrative law judge
				Level 4: Review by the Medicare Appeals Council
				Level 5: Hearing in federal court
			Getting help in making an appeal
Part 5 The Part of Tens
	Chapter 17 Top Ten Medicare Mistakes
		Thinking You Must Reach Full Retirement Age before Signing Up
		Assuming You Don’t Qualify If You Haven’t Worked Long Enough
		Failing to Enroll in Part B When You Should
		Believing You Don’t Need Part B If You Have Retiree or COBRA Coverage
		Not Signing Up for Part D Because You Don’t Use Prescription Drugs
		Picking a Part D Drug Plan for the Wrong Reasons
		Misunderstanding Enrollment Periods
		Being Too Late to Buy Medigap with Full Protections
		Failing to Read Your Annual Notice of Change
		Not Realizing You May Qualify for Help to Lower Your Costs
	Chapter 18 Ten Ways to Stay Healthier beyond Age 65
		Taking Action to Avoid Falls
		Exercising Regularly
		Quitting Smoking
		Eating Healthfully
		Cutting Out Soft Drinks and Extra Sugar
		Keeping an Eye on Prescription Drugs
		Continuing to Work or Stay Active
		Staying Connected and Engaged
		Keeping Your Brain in Shape
		Addressing Tough Choices before They’re Necessary
Part 6 Appendixes
	Appendix A Sources of Help and Information
		Government Help Lines and Websites
			The Centers for Medicare & Medicaid Services
			The Social Security Administration
			State Health Insurance Assistance Programs
			The Eldercare Locator
		Independent Sources of Direct Help
			The Medicare Rights Center
			The National Alliance for Hispanic Health
			The National Asian Pacific Center on Aging
		Resources for Saving Money
		Consumer Information and Advocacy Organizations
		Sources for Updates on Medicare
	Appendix B Glossary
Index
EULA