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Medicare

Book Description

Medicare and its various supplemental plans offers comprehansive health coverage for aging and retired Americans. While this is a "right of passage" for those in their 60s, this program can be complicated and confusing. Idiot's Guides: Medicare is an easy-to-understand guide that explains all of the rules, processes, and benefits-- and how to maximize those benefits. Beginning with a brief background on what Medicare is and why it was established, the book explores all parts of the program, including the prescription drug program, Part D. It also offers tips on closing Medicare coverage gaps and what the future of Medicare may entail.

Table of Contents

  1. Cover
  2. Title Page
  3. Dedication
  4. Copyright Page
  5. Introduction
  6. Part 1: Welcome to Medicare
    1. 1 History of Medicare
      1. Medicare in a Nutshell
        1. What It Is
        2. What It Isn’t
        3. Why Do We Need It?
      2. Medicare vs Medicaid
        1. Socialized Medicine
        2. Separate and Together
      3. Major Moments in Medicare History
        1. Key Players
        2. History in the Making
        3. The 1960s and 1970s
        4. The 1980s
        5. The 1990s
        6. The Twenty-First Century and Beyond
      4. Medicare Today
        1. Baby Boomers
        2. Costs on the Rise
        3. The Affordable Care Act
    2. 2 The Parts and Pieces of Medicare
      1. Finding a Healthy Balance
        1. Physical Health
        2. Mental Health
        3. Social Well-Being
        4. Bringing It Together
      2. Principles of Health Insurance
        1. Who Is Covered?
        2. What Services Are Provided?
        3. Where Can I Receive Care?
        4. How Long Will I Have Coverage?
        5. How Much Will It Cost?
        6. How Medicare Compares
      3. Meet the Crew
        1. Loraine
        2. Eileen
        3. Thomas
        4. George
        5. How to Follow Along
      4. A True Original
        1. Medicare Part A
        2. Medicare Part B
      5. Optional Medicare
        1. Medicare Part C
        2. Medicare Part D
      6. Does Medicare Work?
    3. 3 Limitations of Medicare
      1. What Is Missing?
        1. Dental Coverage
        2. Coverage for Hearing Impairments
        3. Vision Coverage
        4. Services for the Blind
        5. Nursing Home Stays
        6. Geographic Limitations
        7. Other Exclusions
        8. Medicare Is Trying
      2. Partnering with Insurance Companies
        1. Not Enough Federal Dollars
        2. Working with the Private Sector
        3. Conflicts of Interest
    4. 4 Costs of Medicare
      1. Far from Free
        1. Medicare Payroll Taxes
        2. Monthly Premiums
        3. Copays and Coinsurance
        4. Annual Deductibles
      2. Original Medicare
        1. Medicare Part A
        2. Medicare Part B
      3. Optional Medicare
      4. Buyer Beware
      5. What Will You Pay?
  7. Part 2: Enrolling for Medicare
    1. 5 Qualifying for Medicare
      1. When Age Is Not Just a Number
        1. Hitting Age 65
        2. Enrollment Prior to 65
      2. Medicare Tax Dollars
      3. Qualifying Under a Spouse
      4. Qualifying Under Disability
        1. Kidney Disease
        2. ALS
        3. Other Disabilities
        4. Applying for Disability Benefits
        5. Returning to Work with Disabilities
        6. Does Age Matter?
      5. Meeting Plan Requirements
      6. What to Do If You Don’t Qualify
        1. Hopping onto Your Spouse’s Coverage
        2. Extending Employee Benefits with COBRA
        3. Participating in the Health-Care Exchange
        4. Using Your Retiree Health Benefits
        5. Benefitting from Your Union Dues
    2. 6 How to Enroll
      1. Automatic Enrollment
        1. Retiring with Social Security
        2. Benefits of Social Security
        3. Not For Everyone
      2. Applying for Medicare
        1. What Information You Need
        2. Using MyMedicare.gov
        3. Initial Enrollment Questionnaire
        4. Medicare Secondary Claim Development Questionnaire
        5. Keeping Track of Your Insurance Coverage
      3. Applying Under Special Circumstances
        1. Citizens Living Abroad
        2. Domestic Partnerships
        3. Those Who Are Incarcerated
    3. 7 Initial Enrollment Periods
      1. Initial Enrollment
        1. When You Turn Sixty-Five
        2. ESRD
        3. No IEP for You
        4. Late Enrollees to Part B
      2. Medicare Payroll Taxes
        1. How Long, Not How Much Paid
        2. Delay Retirement to Save on Medicare?
      3. Penalties for Late Sign Up
        1. Medicare Part A
        2. Medicare Part B
        3. Medicare Advantage
        4. Medicare Part D
        5. Medigap Policies
      4. Should I Enroll When I Turn 65?
        1. When You Have Other Health Insurance or Benefits
        2. When You Are a Veteran
        3. Pull Out the Calculator
        4. Know Your Budget
    4. 8 Other Enrollment Periods
      1. General Enrollment
      2. Open Enrollment
        1. What You Can Do During the OEP
        2. Annual Notice of Change to Your Plans
        3. Comparing Plans
      3. Medicare Advantage Disenrollment Period
      4. Special Enrollment
        1. When Your Employment Ends
        2. When You Move
        3. When Your Insurance Changes
        4. When You Have Financial Hardship
        5. When You Are Misinformed
        6. When You Want a Five-Star Plan
      5. Enrollment Period Overview
    5. 9 Special Groups
      1. Health-Related Circumstances
        1. Disabilities
        2. Specific Medical Problems
        3. Black Lung Program
      2. Government Employees
        1. State and Local Employees
        2. Federal Employees
      3. Military Service
        1. TRICARE
        2. VA Benefits
      4. Self-Employment and Small Business Owners
        1. If You’re Self-Employed
        2. If You’re a Small Business Owner
      5. Indian Health Service
  8. Part 3: Breaking Down the Benefits
    1. 10 Medicare Part A
      1. The Medicare/Hospital Relationship
        1. Medical Necessity
        2. Hospital Costs
        3. The Two-Midnight Rule
        4. The Three-Day Inpatient Requirement
      2. Services Covered by Part A
        1. Inpatient Care
        2. Rehabilitation and Nursing Home Care
        3. Hospice
        4. Home Health Care
      3. Your Costs with Part A
        1. Monthly Premiums
        2. Late Penalties
        3. Benefit Deductibles
        4. Copays and Coinsurance
        5. Financial Assistance Programs
        6. Total Annual Costs
    2. 11 Medicare Part B
      1. Services Covered by Part B
        1. Ambulance Transport
        2. Doctor Visits
        3. Counseling
        4. Therapy
        5. Laboratory Tests, Imaging, and Procedures
        6. Limited Medications
        7. Medical Supplies
        8. Preventive Screening for Everyone
        9. Preventive Screening for Those at Risk
        10. Preventive Screening for Women
        11. Preventive Screening for Men
        12. When Screening Procedures Become Diagnostic
      2. Services Not Covered by Part B
      3. Cost Summary
        1. Late Penalties
        2. Financial Assistance Programs
        3. Total Annual Costs
    3. 12 Medicare Part D
      1. The Drug Business
        1. How Formularies Work
        2. Copayments and Coinsurance
        3. Promoting Drugs
        4. Free Samples
      2. Choosing the Best Medications
        1. Classy Drugs
        2. Generic vs Brand-Name Medications
      3. Choosing the Best Plan
        1. Drug Exclusions
        2. Choosing the Best Formulary Based on Need
        3. The Donut Hole
        4. Closing the Donut Hole
        5. Mail-Order vs Local Pharmacy
        6. Where to Go for Help
      4. Cost Summary
      5. Low-Income Subsidy
    4. 13 Medicare Advantage Plans and Medigap
      1. Medicare Advantage Plans
        1. How Medicare Advantage Plans Work
        2. What Medicare Advantage Plans Cover
        3. Types of Plans
        4. Enrollment Options
      2. Medigap Policies
        1. How Medigap Policies Work
        2. Types of Policies
        3. Alphabet Soup
        4. Enrollment Options
        5. Swapping Coverage
        6. Guaranteed Coverage
      3. Choosing Between Medicare Advantage and Medigap
        1. Does Medicare Advantage Have the Advantage?
        2. Does Medigap Fill the Gaps?
    5. 14 Employer-Sponsored Health Plans
      1. Do You Need Both?
        1. Employer-Sponsored Health Insurance Alone
        2. Employer-Sponsored Health Insurance with Medicare
        3. Medicare Alone
      2. When Bigger Is Better
        1. Special Enrollment Periods
        2. Family Medical Leave Act
      3. COBRA Considerations
      4. Workers’ Compensation
      5. Who Pays First?
  9. Part 4: Living with Medicare
    1. 15 Selecting Health-Care Providers
      1. What Providers Count
        1. The Path to Doctoring
        2. Nurse Practitioners
        3. Physician Assistants
      2. Picking the Right Provider for You
        1. Accepting Providers
        2. Participating Providers
        3. Limiting Fees
      3. Getting a Second (or Third) Opinion
      4. Are There Enough Doctors?
    2. 16 Using Medicare Cards
      1. When and How to Use Your Card
        1. When to Expect Your Card
        2. Starting to Use Your Card
        3. Paper or Plastic?
        4. Basic Information
        5. Keeping Your Social Security Number Secure
      2. Understanding What the Letters and Numbers Mean
      3. Correcting Errors or Replacing Your Card
      4. Stolen Cards and Identity Theft
        1. Protecting Your Information
        2. Medical Data Breaches
        3. What to Watch For
        4. How to Report Suspicious Activity
    3. 17 How to Read Your Medicare Statements
      1. You’ve Got Mail
        1. Medicare Charges
        2. Payment Options
        3. Late Payments
      2. Medicare Summary Notice
        1. Breaking Down the MSN
        2. Outpatient Services
        3. Inpatient Services
        4. Looking for Duplicate Charges
      3. Understanding Diagnostic Coding
        1. Changing Medical Codes
        2. More Codes (and Confusion) to Come
      4. When You Have Questions
    4. 18 Complaints About Medicare
      1. Filing a Grievance
        1. Customer Relations
        2. Location, Location, Location
        3. Quality of Care
        4. Kidney Disease
        5. Medical Equipment
        6. Medicare Advantage and Part D
      2. Filing a Claim
        1. Delayed Filing
        2. Nonparticipating Providers
        3. Advanced Beneficiary Notices
        4. Medicare Advantage and Part D
        5. If You Suspect Fraud
      3. The Appeals Process
        1. Level 1: Redetermination and Reconsideration
        2. Level 2: Independent Contractors
        3. Level 3: Hearing
        4. Level 4: Medicare Appeals Council
        5. Level 5: Taking It to the Courts
        6. Expediting Your Case
    5. 19 Fixed Incomes
      1. Family Considerations
        1. Grand Families
        2. Insuring Dependents
        3. Social Security Insurance
        4. Temporary Assistance to Needy Families
        5. Foster Care and Guardianships
      2. Tips to Save on a Fixed Income
        1. Medicare Savings Programs
        2. Medicaid
        3. Program of All-Inclusive Care for the Elderly
        4. Programs for Veterans
        5. Help with Utilities
        6. State Health Insurance and Assistance Programs
  10. Part 5: Safeguarding Your Future
    1. 20 Getting Finances in Order
      1. Time to Do the Math
      2. Cost of Living
        1. Basic Needs
        2. Current Spending
        3. Existing Debt
      3. Future Spending
        1. Social Security
        2. Other Sources of Income
        3. Add ’Em Up
      4. How Much Money Do You Need to Retire?
      5. What Can You Do?
        1. Where You Live
        2. On the House
        3. Financial Hardships
        4. Online Programs
    2. 21 The Future of Medicare
      1. The Medicare Trust Fund
        1. Increasing Medicare Eligibility Age
        2. Increasing Medicare Taxes
      2. Increasing Medicare Costs to Beneficiaries
        1. Increasing Premiums
        2. Increasing Deductibles, Coinsurance, and Copays
        3. Decreasing Access
      3. Changing the Practice of Medicine
        1. Defensive Medicine
        2. Shifting from Fee-for-Service to Quality
      4. Changing Medicare Reimbursements
        1. Decreasing Payments to Hospitals
        2. Decreasing Payments to Doctors
    3. 22 Making the Most of Medicare
      1. To Your Health
        1. Rising Rates of Obesity
        2. Eating Right
        3. Get Moving
        4. Get Your Shut Eye
        5. Do Not Fall Victim to Limitations
        6. Visit Your Health-Care Provider
      2. Medicare and Your Health
        1. Enrolling in Medicare
        2. Part A Late Penalties
        3. Part B Late Penalties
        4. Part D Drug Coverage
        5. Employer-Sponsored Health Insurance
        6. How to Pick a Plan
        7. Changing Plans
        8. Going to the Hospital
        9. Going to the Office
        10. Decision Time
  11. Appendixes
    1. A Glossary
    2. B Resources
  12. About the Author