TABLE OF CONTENTS to Medicare For You: A Smart Person's Guide by Diane J. Omdahl, RN, MS
GET MEDICARE RIGHT IN 7 EASY STEPS
INTRODUCTION
STEP ONE: PREPARE FOR MEDICARE
Learn the terms.
- Medicare Part A, B, D.
- Medicare supplement plan.
- Medicare Advantage plan.
- Guaranteed issue right.
Buy a bigger mailbox. Get another recycling bin. Put new batteries in your remote control.
- Facts about TV ads.
- Resist calling the phone number on the screen.
Establish or update your healthcare power of attorney.
Confirm your eligibility for Medicare.
- Eligible to enroll in Medicare.
- Eligible for premium-free Part A.
Create a my Social Security account.
Know when to take action.
STEP TWO: DETERMINE YOUR TIMING
Three enrollment periods that are for getting into Medicare.
Initial Enrollment Period - everyone must pay attention.
- Myth: must enroll at age 65.
- Guidance for specific situations
- Receiving Social Security benefits before age 65.
- Giving up coverage or no coverage.
- Employer group health plan.
- 20 or more employees.
- Fewer than 20 employees.
- Keeping coverage after age 65.
- HSA
- Creditable drug coverage.
- Other types of coverage (COBRA, individual, retiree, VA).
- Enrollment instructions.
Part B Special Enrollment Period -for those who could delay enrollment.
- Who qualifies.
- Enrollment instructions.
General Enrollment Period - oops, you're too late.
- Enrollment instructions.
- Late enrollment penalty.
STEP THREE: GET TO KNOW THE PARTS OF MEDICARE
Confusion: Medicare has four parts.
Medicare has three parts and they combine to make two paths.
First the three parts.
- Medicare Part A.
- Medicare Part B.
- Medicare Part D.
Then the paths (introduction).
- Original Medicare.
- Medicare Advantage.
STEP FOUR: PICK YOUR BEST MEDICARE PATH (HOW THEY WORK)
Original Medicare
- Medicare supplement (Medigap policy) and Part D drug plan.
- Physicians, rules.
Medicare Advantage
- Types of plans.
- Networks.
- Coverage rules
- Out-of-pocket maximum.
- Medicare giveback.
- Extra benefits.
Changing paths down the road.
- Guaranteed issue right.
- 46 states and NY, CT, MA, ME.
- Medigap OEP.
- Medicare Advantage Trial Period.
- When to change paths.
- Open Enrollment Period.
- Medicare Advantage Open Enrollment Period.
- Other opportunities.
- Moving out of plan's service area.
STEP FIVE: LIVING WITH MEDICARE
Part D drug coverage.
- Networks, preferred and standard pharmacies.
- Tiers of drugs.
- Formulary.
- Payment stages.
- Drug plan deductible.
- Donut hole.
- $35 insulin.
Medicare costs.
- Part B premium.
- Medicare supplement, drug plan, Advantage plan.
- Premiums.
- EOB.
- Medicare summary notice.
IRMAA.
- Life-changing event.
- One-time income.
Preventive services.
- Welcome to Medicare visit.
- Annual wellness visit.
- Vaccines.
- Part B - flu, pneumonia, COVID.
- Part D - shingles.
Moving.
POA not enough
- Medicare representative.
- Plan representative.
Medicare scams.
STEP SIX: KNOW WHEN YOU NEED MORE HELP
SSDI.
Not eligible for premium-free Part A.
Domestic partner.
FEHB.
Coverage after employment ends.
- COBRA.
- Retiree plan.
- VA, TFL.
Expatriate.
HSA.
Appeals.
STEP SEVEN: PAY ATTENTION TO COVERAGE EVERY YEAR
Open Enrollment periods.
Notice of changes.
Update Social Security information
INDEX
REFERENCES
