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
			Medical supplies and equipment
		Knowing What Part D Covers
			Making sense of drug coverage that can vary throughout the year
			Finding out about formularies
			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
			Limits on skilled nursing facility stays
			Limits on mental health benefits
			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
			Part B costs
			Part D costs
			Medicare Advantage costs
		Paying Higher-Income Premiums
			Understanding who’s liable for the surcharges
			Figuring out what the surcharges cost you
			Getting the surcharges waived
		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
			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
			Choosing a drug plan with Extra Help
		Considering Other Ways to Cut Costs
			Taking income tax deductions for Medicare costs
			Lowering drug costs without Extra Help
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
			Qualifying for Part A on your own work record
			Being eligible for Part A on someone else’s work record
		Qualifying for Medicare under Age 65 on the Basis of Disability
			Receiving disability payments
			Suffering from permanent kidney failure (ESRD)
			Living with Lou Gehrig’s disease (ALS)
		Falling through the Cracks: Health-Care 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 health care 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
			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
			You’re in a nontraditional marriage or domestic partnership
			You’re incarcerated
		Deciding Whether and When to Sign Up for Part D Drug Coverage
			Assessing drug coverage you have from elsewhere
			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
			Passing your deadline for Part A
			Neglecting your deadline for Part D
			Figuring out whether you can get a late penalty revoked
	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
			Enrolling while you’re living abroad
		Opting Out of or Disenrolling from Part A or Part B
			Declining Part A
			Opting out of Part B
			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
			Knowing how and when to switch from Marketplace to Medicare
	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
			Having insurance from a former employer
		Figuring Out How Other Federal Health Benefits Fit In with Medicare
			The Federal Employees Health Benefits Program
			TRICARE and TRICARE For Life
			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
			Weighing the two systems
			Recognizing when you may not have a choice
			Being on your guard against “auto-enrollment”
		Digging into the Details of Traditional Medicare versus Medicare Advantage
			Opting for traditional Medicare
			Looking at Medicare Advantage 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 Traditional 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
		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
			Drilling down to important bits of info when comparing Part D plans
		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’ medical benefits
			Adding prescription drug coverage
		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
		Buyer Beware! Avoiding Scams and Hard-Sell Marketing
			Steering clear of outright scams
			Resisting hard-sell marketing tactics
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
			Replacing your cards
		Beyond the Cards: Checking Out the Extent and Limits of Your Coverage
		Managing Premiums
			Discovering different ways to pay Medicare premiums
			Knowing what can happen when you don’t pay your premiums on time
		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
		Filling Prescriptions for the First Time with a Part D Plan
			When does my coverage begin?
			Which kind of pharmacy can I use?
			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?
	Chapter 14 Getting the Inside Scoop on Using Certain Medicare Benefits
		Taking a Closer Look at Part A
			Understanding hospital benefit periods
			Taking note of the three-day rule
			Defining observation status
			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
		Zooming In on Part B
			Checking on whether Medicare will cover your treatment
			Receiving a notice saying that Medicare may not pay
			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
		Delving into Part D
			Understanding how a plan may restrict your drug coverage
			Grappling with the tier system of co-pays
			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 or Disenrollment
			The open enrollment period
			The disenrollment period
		Taking Advantage of Special Enrollment Periods
			Recognizing when you can use SEPs to change plans
			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
		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
			Seeking a second opinion
		Asking for an Investigation
			Requesting equitable relief
			Contacting an ombudsman
			Reaching out to your Quality Improvement Organization
			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
			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