Medicare 101
Medicare 101
by Joe O. Clark
Published by Joe O. Clark
Copyright 2011 Joe O. Clark
All Rights Reserved
Smashwords Edition
ISBN- 978 1465886712
Revised October 28, 2011
Discover other titles by Joe O. Clark at
I appreciate you respecting the hard work and effort of this author by not sharing your copy of this book.
Thank you
HOW THIS BOOK WORKS
These first pages break down the complex and confusing subject of Medicare and make it easier to understand and learn. This should help you to make educated decisions.
*While the facts are accurate, these pages reflect my opinion
The remaining pages are designed to be a detailed look, with the focus on the choices I believe will provide you with the best protection available for the money.
At a minimum, read and understand the first pages.
If you want the maximum amount of detailed information get on the web at medicage.gov and you can research it until your eyes drop out.
“When a mouse eats an elephant it is important to take small bites and start at the tasty end!”
All insurance is wonderful until you have a claim.
Study to avoid costly errors.
Planning
Up until now your entire life has been dependent on planning. How well you succeed is directly related to how well you plan or fail to plan.
Retirement does not change the necessity to plan. That is why you are reading this book.
If you are waiting until you are older to plan for your retirement; your retirement is likely to be less than you would like it to be! Keep buying those lotto tickets!
You can avoid reality but you cannot avoid the consequences of avoiding reality.
-- Ayn Rand (1905 – 1982)
KISS (Keep It Simple Sugar)
My method of helping you understand Medicare is to break it down into bite sized pieces.
All the data is too overwhelming to make sense of readily or easily.
The answers that best serve the government do not serve you best.
The answers that best serve the insurance company do not serve you best.
Premise – No one can know it all!
In the field where you made your living is it possible that an individual with end user knowledge of your line of work could bring themselves up to speed by researching the subject on the internet; Or is it more likely they might be led astray by some internet marketing expert?
This book hopes to teach you enough to know if your chosen adviser is going the proper direction.
I hope to make you aware that being healthy can be a trap and cost you everything you have.
Drawing Social Security
There is a brochure at http://crr.bc.edu/special_projects/social_security_claiming_guide.html which explains when, how and how much.
If you don’t need the money to live on immediately it might be worth your while to wait to begin drawing it. This is providing you think you will live long enough to draw it later.
Part B Option
If you avoid paying for Part B you will not be eligible for ANY supplemental health insurance such as Medicare Supplement (Medigap) or Medicare Advantage.
Without Part B you may only have Original Medicare and a Prescription plan.
The exceptions are few and covered later in this book.
Who Can You Trust?
Insurance Agents, Financial Advisers, Lawyers!
Find out what they are pushing! If they are totally focused on one product or solution you need to carefully consider your alternatives.
Be very careful whose advice you take but you absolutely need advice from all three of these.
Laws change at least every year.
Many insurance plans change each year.
Certainly the financial situation in the country changes continually.
What About a Zero Premium Plan?
This is a good option if you are broke or you would like to be. It is called Medicare Advantage.
With this type of plan you elect to have your coverage from an insurance company (HMO/PPO) rather than through Medicare direct. This includes most retirement plans.
There are some questions you urgently need answers to before going with one of these plans:
How much is my annual maximum out-of-pocket limit?
That is the most you would have to pay in addition to what the insurance pays.For 2012 the limit by law is $6,700.
How much is my monthly premium?
I know I said zero premium but that does not stop the insurance company from asking for a premium.
Many of them have a monthly premium and still set the annual limit at the legal limit and have high co-pays too.
How much do I pay if I go to the hospital for 5 days?
Many of these plans push $300 a day which is rather hard to reach.
Does my doctor accept this plan.
Ask your doctor, not the insurance agent.
The Best Solution for Most People
Original Medicare which is Part A
Outpatient coverage which is Part B
A prescription plan which is Part D
Medicare Supplement (Medigap) Plan F.
This will cost you a premium of about $200/month but you will have no co-pays, no co-insurance, and can go to any doctor in the United States who accepts Medicare, without a referral.
You can take my word for it or just keep reading.
Don’t let an insurance company or Medicare steal your nest egg!
No one wants to run out of money!
Beware!
It is dangerous to be healthy and take little or no medicine. You start thinking you are bullet proof.
Have you ever witnessed a car wreck? Accidents happen and are NEVER planned.
If you are injured your options for supplemental coverage will be very limited. See the definition of Medical Underwriting.
What Happens if I Do Nothing?
You go into Original Medicare Part A!
You have no outpatient coverage without Part B and no prescription coverage without Part D.
Original Medicare covers hospitalization care at 80% after you pay $1,132 deductible for days 1-60.
Medicine and medical equipment is included while you are hospitalized.
If you are already drawing Social Security, Part “A,” then Part “B” will be automatic and the $99.90/month Part “B” premium will be deducted from your Social Security benefits.
To join a Medicare Supplement (Medigap) plan OR a Medicare Advantage plan you must have Part “B”.
If you are still working and covered by an employer group plan talk to your plan benefits administrator.
Your benefits administrator will best understand how your company coverage might work with Medicare. They might be biased toward HMO/PPO so be careful.
If your employer plan ejects you because you are Medicare eligible call a Medicare Specialist after you talk to your benefits administrator. If you phone an insurance company you will get answers that are most profitable for the insurance company.
Beware of any advisor who sings a song with only one note.
Who Said Medicare is Optional?
When you turn 65 and leave your work-related health insurance, you go on Medicare.
Who cares if you don’t like it?
If you want to go to a doctor or facility that DOES NOT accept Medicare Assignment that is your right.
You will have to pay for it out of your pocket. If you are ill enough and have the money this is a minor consideration.
If you are concerned by the number of doctors who do not accept Medicare assignment, tough!
Medicare is not truly optional and doctors are at liberty to not accept the lower rate Medicare is willing to pay them. For general health purposes this is not a problem.
Many really fine doctors do accept Medicare assignment.
In addition to having the right to not accept Medicare assignment doctors may limit their Medicare practice and many do. How can they afford for all their business to be seriously discounted?
If you have difficulty discerning the difference between the way you think things should be and the way things are, this book will probably only aggravate you. It will also educate you but you probably will not be happy with what you learn.
ALL Medicare plans only cover one individual
What is best for the government is NOT best for you!
What is best for the insurance company is NOT best for you!
When you phone an insurance company, whatever they recommend is going to be what is best for that company.
DON’T PHONE THEM! Call a Medicare Specialist.
Find an insurance agent who specializes in Medicare and NOT focused on selling Medicare Advantage.
This will certainly not include any agent who works for only one insurance company.
If you deal directly with an insurance company they save paying the agent a commission.