From the Medicare Rights Center – Getting Medicare right
1. Choose Wisely – Choose wisely when you decide what kind of Medicare coverage you want. There are two ways to get Medicare health benefits: through Original Medicare or Medicare Advantage.
Original Medicare – This is health insurance from the government. It’s what most people choose. Its lets you go to almost any doctor or hospital. Many people chose to buy supplemental insurance (Medigap plans) to help cover coinsurance and deductible costs.
Medicare Advantage – Private insurance companies sell Medicare Advantage plans. They’re often HMOs or PPOs. They cover Medicare benefits, but each plan has its own rules and costs. These rules may restrict which providers you can see and require you to get permission before you can receive certain services.
Most people must stay with their choice for the calendar year. Make sure it meets your needs and works with your other drug and health insurance.
2. “B” Careful
Part B is the part of Medicare that covers outpatient services and doctor’s visits.
Generally, you should sign up for Part B when you first become eligible for Medicare. If you are working, check with the Social Security Administration to find out if your current employer insurance is primary to Medicare. If it is, you may consider delaying enrollment into Part B, but you must sign up as soon as you stop working.
If you don’t sign up for Part B when you should, you may have gaps in your coverage. You may also have to pay a penalty.
3. Prescription for Health
You may want to sign up for a Part D drug plan to get coverage for prescription drugs. If you have Medicare Advantage, drug coverage is usually included in your health plan. If you have Original Medicare, you must chooose a separate drug plan from a private insurance company. Important reminders:
When choosing a drug plan, make sure it covers the drugs you take.
Find out if the plan has any restrictions on the drugs you take — such as quantity limits, prior approval, or a requirement that you try other drugs first.
Learn how much the monthly premium is, and check how much the deductible and copays are before you sign up for a plan.
4. Don’t Take No for an Answer
Whether you are in Original Medicare, a Medicare Advantage plan, or a drug plan, you can appeal if any of them denies coverage.
An appeal is a formal request asking a plan to change its decision and provide you with coverage.
Many people win their appeals. If you don’t win at first, you can continue to appeal to the next level.
There are a number of reasons you may appeal a drug plan’s decision. You can appeal if the plan is restricting the quantity of the drug you can get, making you get prior approval, having you try other drugs first, or if your drug is not on its list of covered drugs (formulary).
5. Save Money Now
Apply for programs that can help you pay your Medicare costs. If you are eligible, these programs can help pay your premiums, copays and deductibles for both health and drug coverage.
Apply even if your income and assets seem to be above the limits; some income and assets may not count towards the limit.
Programs include: Extra Help, Medicare Savings Programs (MSPs), State Pharmaceutical Assistance Programs (SPAPs) and Medicaid.
Contact your local SHIP (State Health Insurance Assistance Program) to find out which programs are available in your state, if you are eligible, and how to apply.
6. What’s Not Covered
Medicare does not cover all health care services and products.
Those that are not covered include:
Most dental care
Most personal or custodial care at home or in a nursing home
Most cosmetic surgery
Most vision care
Most care received outside of U.S.
Most nonemergency transportation
Medicare Advantage plans may cover some of the above services.
For more information, visit www.MedicareInteractive.org.
Medicare Interactive is an online resource that provides answers to all your Medicare questions.