Medicare Made Simple? Not Quite: Decoding the Alphabet Soup to Maximize Your Coverage

 


Medicare plan options are confusing. This book may help.

For all its pluses, Medicare can be a hellish system that befuddles and frustrates so many beneficiaries.

Medicare provides health insurance for millions of Americans 65 and older, as well as coverage for younger people with certain disabilities and those diagnosed with end-stage renal disease. It’s both a lifesaver and an alphabetic nightmare.

Part A is hospital insurance. Part B is medical insurance, covering doctors’ visits, outpatient care and other medical services. Part C is Medicare Advantage, which is offered by private companies approved by Medicare, such as anHMO. And Part D is prescription drug coverage.

Enrollees in need of extra coverage also can sign up for Medicare Supplement Insurance. There are 10 types of such Medigap plans, which also are identified by letters A to D, F, G, and K through N.

“Confusion now hath made his masterpiece” from William Shakespeare’s “Macbeth” comes to mind.

Those who qualify for this government benefit have choices to make during open enrollment, which ends Dec. 7.During this period, enrollees can change their health care and prescription drug plans.

Even if you’ve been happy with your coverage, open enrollment is the time to reassess what you have and make changes.

If you are enrolled in Medicare or will be in the future, I have a reading assignment for you. No, it isn’t an easy, breezy beach read, but it can help you get the most out of the program. It’s the 2024 version of “Get What’s Yours forMedicare: Maximize Your Coverage, Minimize Your Costs,” which I’ve selected for the Color of Money Book Club.

The author is Philip Moeller, a longtime journalist who writes the “Aging in America” newsletter on Substack. He’s become an expert on so much related to Medicare and Social Security. You can find his work at GetWhatsYours.org.

Right away, in a subchapter headline, Moeller says, “Take a breath.” He’s right.

“The program has this extensive range of benefits, but it also has these incredibly complex rules,” Moeller said in an interview.

Be prepared, because he takes you into a deep dive into the Medicare world, including the increasingly controversialMedicare Advantage plans. Although more resources are available to help people navigate the system, it helps tohave an unbiased guide and some key tips:

Enrolling at the right time. “You can, in theory, find out nearly everything you need to know by going toMedicare.gov and spending hours hunting for information that you didn’t know you need. Finding a needle in ahaystack is tough enough, but at least you know what the needle looks like.”

Getting the right coverage. There are a lot of options for Medicare. So Moeller walks you through the options.“Do not expect Medicare or your insurers to do this for you,” he writes.

Understanding what the plans cover. “Plans can change a lot from year to year. If you don’t know whether your plan has changed, please find out.”

For example, when you receive your “Plan Annual Notice of Change,” look for any changes in your plan, such as a possible increase in cost or coverage areas. It’s important to review this document, because it allows you to compareyour existing benefits with those on tap for 2025. Be sure to check your prescription drug plan to ensure your medications will still be covered. If a drug you take is no longer covered, you may want to switch plans. If you didn’tget your notice, contact your insurer.

I highly recommend you spend some quality time with the chapters on Medicare Advantage plans.

In 2024, 32.8 million people enrolled in a Medicare Advantage plan — about 54 percent of the eligible Medicare population — according to a trends report by KFF.

This time of year, commercials for Medicare Advantage plans are ubiquitous. But don’t get sucked in by promises in the ads. It’s not all medical insurance nirvana.

For many, the plans work and save them money. For example, 75 percent of enrollees in individual MedicareAdvantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium,according to an analysis by KFF.

However, there are a lot of issues with these plans. I’ve heard from many readers complaining about limitednetworks, the byzantine requirements for prior approval for certain care, the subsequent delays, and deniedpayments.

Moeller provides a useful list of questions to ask before signing up. I also would suggest doing further research,including searching for “Medicare Advantage” on KFF’s site.

There’s a frequently asked questions section in the back of the book, which really is a good place to start if you’re feeling a little overwhelmed.

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