Medicare & Me

If there’s anyone out there still thinking your information is private, I’m here to tell you it’s not. The health insurance companies started filling my mailbox with information on Medicare at least six months before my 65th birthday. They have apparently been watching and anticipating my big 6-5 along with the United States government. Despite the overload of information everything was as clear as the road before you on a foggy night.

Even the federally provided booklet Medicare & You didn’t clarify the subject. I consider myself a reasonably intelligent person. However much I thought I understood the government’s booklet, there was still a doubt, a HUGE doubt, that I had indeed grasped all the nuances. Convoluted doesn’t begin to describe it — Parts A, B, C, D, F, G and more.

Fortunately, the Osher Lifelong Learning Institute I attend at Furman University offered a course last fall in Understanding Medicare. I signed up. With each class dedicated to a lettered Part, the fog began to lift. The idea that it takes an hour and a half to explain Part A and so on is ludicrous. I wondered what people who don’t have access to a course do to understand and make an informed decision.

As my mailbox continued to hold offers from all kinds of insurance companies and agents, some of which I had never heard of, I piled their correspondence and applications on my desk. My strategy was to sift through them after finishing the class. However, our instructor recommended going with one of the five large, well-known carriers in the state. Since that made perfect sense to me, I eliminated all the rest. My pile shrunk by two-thirds, making the task less daunting.

If you are already receiving Social Security, you don’t need to apply for Medicare. You are automatically enrolled. Keep your eyes open for the government envelope carrying your Medicare card for Parts A and B. It does not look official! I almost threw mine out thinking it was from yet another unheard of insurance company. If you are not receiving social security, you have to apply for Medicare; you have 3 months before your 65th birthday and 3 months after to do so.

Since Part A is provided by the government, courtesy of your Medicare taxes while working, and Part B is provided by the government and paid for by a monthly premium from you, what you are really looking for from insurance companies is prescription drug coverage and supplemental insurance. Part A provides hospital coverage and Part B provides coverage for items such as doctor visits, flu shots and walkers. There are deductibles and co-pays, which is why you are getting supplemental insurance coverage also known as Medigap. You are not required to get supplemental insurance, but if you don’t, understand you will have to pay deductibles and co-pays from your pocket.

Some people opt for Part C known as the Advantage Plan, which means you have private insurance and do not use the federal government’s Parts A and B. The insurance company receives what the government pays for Part A as well as your Part B premium. Not all insurance companies have Part C plans. Most Part C plans have a co-pay for doctor’s visits. The real caveat is you have to use in-network providers including your primary physician. So Part C can be a problem if you travel, have a medical issue and your primary physician is not there and there is no in-network hospital. You will end up paying out-of-network rates and most likely have to pay the difference from your pocket. This is why I didn’t go with an Advantage Plan.

Note: If you travel to foreign countries be aware that Medicare does not cover you outside the United States. If you go with the Advantage Plan Part C ask for a copy of the policy before you apply and read it. In fact, read whatever policy you decide to buy. Knowledge is power!

Part D is prescription drug coverage. What company you choose for Part D will depend upon your prescriptions. Different companies have different tiers for drugs. Deductibles and co-pays vary from company to company along with which tier they put a drug into. Make sure you review what tier your drugs are in with each provider and what your out-of-pocket cost will be in addition to the cost of the coverage.

I went with Part F as my supplemental insurance. Part F covers deductibles and co-pays for both doctors and hospital stays. I can go to any doctor or hospital I want and don’t have to be concerned about “What if something happens while I’m traveling?” I do not have to be in-network. I also have 80% hospital coverage if I’m in a foreign country and have a medical issue.

The other letters such as G, L and N are simply other versions of supplemental insurance. You have to read about them in order to make the best choice for your individual situation. If you don’t have access to a course, I recommend calling AARP (800-272-2146) to speak to a United Healthcare agent as I found their agent to be the most knowledgeable, articulate and willing to spend the time reviewing the intricacies of Medicare. I receive nothing for making this recommendation to call AARP.  I did not go with United Healthcare as I chose to stay with the carrier I’ve had for the last 25 years even though they cost $3 a month more for my premium. This was one time I wasn’t leaving my comfort zone.

All of us in the United States will have to go through this process as we approach 65. I doubt it will become any less convoluted in the future. I hope this small explanation helps. For more information go to SSA.gov or medicare.gov. And good luck!

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