Medicare For Dummies. Patricia Barry
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and again. Here’s what they mean.
Beyond the Book
In addition to the material in the print or e-book you’re reading right now, this product also comes with some access-anywhere goodies on the web. For important Medicare dos and don’ts, pointers on enrolling in Medicare at the right time, and key sources of Medicare help, go to www.dummies.com and type “Medicare For Dummies Cheat Sheet” in the Search box.
Where to Go from Here
Nobody expects you to read this book cover to cover. It’s not a thriller or a bodice-ripper! But it does act as a plain-language reference to a program that millions of people use but few understand. So you can jump in anywhere to the bit you need, at whatever point you happen to be when grappling with Medicare. For example:
Want to know how Medicare works? Start with Part 1 to see what Medicare covers, how much it costs, and how you can lower expenses.
Don’t know when you should sign up or how to go about it? Chapters 6 and 7 show you the way, according to your circumstances.
Need to make a choice among Medicare’s many options and private plans? Find out how to do so in Chapters 9, 10, 11, and 12.
Want to get the best out of your Medicare coverage and avoid pitfalls? You’ll find lots of pointers in Part 4.
Part 1
Getting Started with Medicare
IN THIS PART …
Set the record straight on common assumptions and misconceptions about Medicare and how it compares with other types of health insurance.
Discover the basics of Medicare with a quick primer on how it’s divided into four separate programs: Part A (hospital stays), Part B (doctors’ and outpatient services), Part C (Medicare’s private health plans), and Part D (prescription drug coverage).
Find out which services Medicare helps pay for, which services it doesn’t cover at all, and which ones come with certain coverage limits.
Recognize what you’re likely to pay toward your costs in Medicare — the basic premiums, deductibles, and co-payments, plus the premium surcharges you may have to pay if your income is over a certain level.
Get the scoop on ways to reduce your out-of-pocket expenses in Medicare, including special help if your income is under a certain level.
Chapter 1
The Nuts and Bolts of Medicare: What It Is and How It Works
IN THIS CHAPTER
Medicare is a federal government insurance system that helps more than 60 million seniors and people with disabilities pay for their health care. It’s the only truly national health-care program in the United States — meaning that it’s available regardless of your income, the state of your health, or where you live nationwide — and it has been enduringly popular since it began in 1966.
Yet Medicare works like no other insurance you may have known in the past. To avoid total confusion, you’re wise to gain at least a broad understanding of how the program is put together and how its rules may affect you personally.
This chapter provides an overview of the program: addressing common concerns about how Medicare is different from other types of health insurance; describing the four parts of Medicare coverage (A, B, C, and D); and providing a checklist for the decisions that you have to make in choosing among the coverage options that Medicare offers.
Addressing Some Upfront Questions
When the prospect of becoming a Medicare beneficiary looms on the horizon, you suddenly become aware — if you’re like most people — of how little you know about the program. And even if you think you know, can you be sure that the information you have is accurate? Based on questions I’ve received, I can tell you that a lot of perceptions about Medicare are way off base; quite often, they’re gleaned from the internet or even mass emails that are deliberately designed to spread misleading information and scare seniors.
But if you’ve had health insurance in the past, especially from an employer, you may be nervous about how Medicare coverage compares with it. So before I examine how Medicare actually works later in this chapter, I want to tackle some of the concerns people frequently raise about the program:
As a government-run system, will Medicare give me inferior care? No (or at least, not inherently). The federal government runs and regulates Medicare and also largely pays for the medical services you use. Even so, those actual services are almost wholly private. The doctors you go to are not government employees; the hospitals and laboratories that provide services to you are not government-owned. Instead, they’re free to enter or not enter into contracts with Medicare as they choose. Those who accept you as a Medicare patient are the same kind of independent, private practitioners that you would’ve seen for diagnosis