Is it just me or are the publications of Medicare books sent to us by the government written by lawyers, why can't they be written in plain understandable English, they are almost as bad as assembly instructions for furniture.....
Um, I don't have and issue understanding the book. I have harder time trying to pick thru which plan to go with. But I have had a good plan for 4 years and will stay with it again next year.
When we get our new Medicare book and/or Humana Drug Plan book, it automatically goes into a filing box we have. Might, and note the word "might", take a fast look through both, but that's it. For the last number of years, all I've used my Medicare for is a trip to the ER for a fall in August 2019, my Senior Flu shot and my eye/vision exam. Anything else, I use my VA Medical. I have to agree with Samuel, the book isn't the easiest to read/understand.
I only read it at the very beginning of being eligible. Now I'm comfortable in my health plan and don't need it anymore.
Glad we have our national health service with all its faults so we don’t have to worry about this kind of thing.
This is not a book, just a short, informative article on Medicare from the Wall Street Journal. https://www.wsj.com/articles/5-mistakes-medicare-plan-a26d73fb?mod=hp_listc_pos3 “Mistake 1: Underestimating the costs of traditional Medicare First, let’s get some jargon out of the way. Traditional Medicare, which is offered by the government, has three parts, A, B and D (it isn’t a typo that I left out C). Part A covers care for inpatient hospital services, among other things, while Part B covers physician services. Part D is for prescription drugs (we will cover this later). The big appeal of traditional Medicare is that you can visit any hospital or doctor without a referral or prior authorization of services. This can be very attractive if, for instance, you have doctors you trust; travel a lot within the U.S. and might need care in different places; or think that you might benefit from a treatment that a private insurer may deny. Yet many people don’t really weigh the options when considering traditional Medicare. Instead, they choose it without, well, actually choosing it. The reason: Social Security. If you claim Social Security before age 65—as almost half of Americans do—the Social Security Administration automatically enrolls you in traditional Medicare when you turn 65. As such, traditional Medicare, for many, is the path of least resistance. Traditional Medicare, though, may be a bad fit for your needs—and your wallet. The plan’s flexibility comes with significant costs. True, Part A premiums are often zero for those who have worked for at least 10 years (and as much as about $500 a month if you haven’t). But Part B carries premiums that are based on your income. For most people, the Part B premium cost comes to about $165 a month, but can rise to over $500 a month per individual if your household modified adjusted gross income exceeds about $370,000 (over roughly $180,000 for individuals). With traditional Medicare, meanwhile, a hospitalization (with some exceptions) is accompanied by a $1,600 deductible. Likewise, a hospital stay longer than 60 days carries a $400 copayment a day, and a skilled-nursing-facility stay longer than 20 days will cost $200 a day. You will also be responsible for 20% of the Medicare-approved cost of physician services during your hospital stay. This kind of cost-sharing can break most retirees. A breakthrough cancer therapy like Keytruda, for instance, has an annual cost of $150,000, so a patient would have to pay $30,000. But a typical Medicare beneficiary has an income of $35,000 annually, leaving just $5,000 for taxes, housing, food and everything else. Mistake 2: Underestimating the costs of Medicare Advantage Ignoring costs can go the other way too—some people will choose Medicare Advantage plans without really understanding the real price tag. Let’s untangle a bit more of the jargon. Medicare Advantage is an alternative to traditional Medicare: You must first sign up for Medicare Parts A and B, and then you can sign up for a Medicare Advantage plan. Often called Part C, this option is usually a bundle of A, B and D, delivered by private companies that are approved by Medicare. (Be careful, though: Some Medicare Advantage plans don’t include prescription-drug coverage, so be sure to check. You can find more information about those cases here.) Medicare Advantage companies often tout “zero premium” plans, and some offer out-of-pocket expenses lower than traditional Medicare and are often zero. What’s more, some plans cap out-of-pocket expenses at a total of $9,500 for combined in- and out-of-network coverage (the details depend on the plan). In addition, Medicare Advantage companies are paid a fixed amount of money each month by the government. So the companies have a strong incentive to reduce their costs by providing more generous coverage for medicines that keep you out of the hospital. But some of those positives are slightly misleading. Zero premium applies to Part A and D, meaning that you are still paying the Part B premium. Meanwhile, those cost savings on out-of-pocket expenses only apply if you stay in network. If you go out of network, things can quickly become very expensive, like having to pay 20% coinsurance on hospital stays. If your hospital stay costs $40,000, you’re on the hook for $8,000. This in-network and out-of-network distinction limits where you can go, both where you live and in other regions, which can make Medicare Advantage the wrong choice if you need to access a particular doctor or hospital, or spend a lot of time in different parts of the U.S. Some Medicare Advantage plans will cap your financial exposure to out-of-network use, so pay attention to the amount that you will incur. If you do opt for Medicare Advantage, you will also need to do some homework: The typical Medicare beneficiary has access to around 40 Medicare Advantage plans in their area—and most do a lot of heavy marketing—so choosing carefully is important. The HMO options are the cheapest (in part because they charge when you are out of network for nonemergency care, and want a referral for a specialist visit), followed by local PPO plans and then larger PPO plans. If you’re not traveling a lot and are happy with the doctors and hospitals in the HMO plan, then you should not pay for a PPO plan. Mistake 3: Choosing traditional Medicare without Medigap Medigap—supplemental insurance sold by private companies—helps traditional Medicare beneficiaries pay for the cost sharing in Parts A and B. For instance, one Medigap plan in my state of Massachusetts—which carries a $220-per-month premium—covers the $1,600 hospital deductible for traditional Medicare, and the nursing facility copayment for over three months. Yet almost 10% of people who choose traditional Medicare don’t have any supplemental coverage, which you can get by purchasing a Medigap policy; through Medicaid (which depends on income); or through an employer, if it offers one. Many people simply don’t know about Medigap plans, are confused by the choices or don’t have the money every month to spend on them. Obviously, this could leave you exposed to high costs. If you can’t afford Medigap premiums, then pick a Medicare Advantage plan. The specifics of Medigap can get a bit confusing. There are 10 types of plans—also called Medicare Supplement Insurance—that vary in the degree to which they pick up the cost-sharing in traditional Medicare: Medigap A through D; then F and G; and finally K through N. Those letters, though, have nothing to do with your Medicare Part A, B and D cost-sharing. Just remember this: All Medigap policies with the same letter cover the same set of things. (If you’re confused, you’re not alone. Even with a Ph.D, I have to look this up all the time.) Making things even trickier to figure out, Medigap is regulated both by Washington and the states, so planswork differently in different states. The federal government’s Medicare.gov site explains what the difference in Medigap plans is, and allows you to see the Medigap premiums you will face based on state, age, gender and whether or not you smoke. Mistake 4: Forgetting to get prescription coverage As with Medigap, many people simply don’t know a basic fact about Part D of traditional Medicare: You aren’t automatically enrolled in it along with Parts A and B. You must actively select this plan, which covers prescription drugs. Not doing so can leave you stuck with the cost of prescriptions yourself. And not choosing promptly can also cost you. You have only 63 days after your initial enrollment in Medicare to enroll in Part D. If you miss this window and don’t have other drug coverage—some people may get it through an employer, for instance—your Part D premium will be permanently higher. For every year that you don’t make a choice, your Part D premiums will rise by about 12%. Part D premiums are tied to income, with an average cost of $43. Like other parts of Medicare, there is a lot of choice in Part D plans. Medicare beneficiaries in New York, for instance, can choose among 19 different plans, and 28 in Arizona. These plans aren’t the same, and it is all too attractive to choose the ones with the lowest premium, which means that people have to spend more when they are sick. Small expenses like $5 and $10 on prescription drugs have been shown to discourage patients with chronic disease from taking lifesaving medicines, leading to hospitalizations and death. Mistake 5: Not checking out your broker Sorting out all of that takes a lot of work. So, it is understandable that 1 in 3 Americans turn to brokers to advise them on which plan to choose. Here, too, things aren’t as simple as you might think. Brokers can be extremely helpful, but routinely neglect to tell their customers that they are paid $400 to $500 per enrollee by insurers, often to sell more expensive plans, which creates a fundamental conflict of interest in the advice they provide. So, if you go down this path, make sure to ask them questions about their incentives, the plans that they’re not telling you about and whether the discounts they are offering you will dry up in a year or two. If you asked me to simplify things and suggest a choice that would work for most people, then I’d encourage you to pick a Medicare Advantage plan that has a prescription-drug plan attached to it. Pick a plan that limits how much you can be charged for out-of-network services, and don’t buy one with limits that you can’t afford. If you’re filing your taxes jointly and are fortunate to have more than $250,000 in income (or about $125,000 on an individual return), consider traditional Medicare with a Medigap policy that covers all your Part A and B care. It will be much easier for you to weather the costs, and you avoid the hassles of tracking when you go in and out of network, as well as getting prior authorizations. (People with lower incomes could afford this choice, but make sure that the level of coverage suits you.) Also note that neither traditional Medicare nor Medicare Advantage cover long-term care in a meaningful manner. Almost all of us will need this care, and we will have to save to pay for it, or ensure that our families will provide it. One good strategy for saving is a health savings account (HSA), which allows people with high-deductible health plans set aside pretax dollars to pay for qualified medical expenses. A good resource for advice is a State Health Insurance Assistance Program, or Ship. They operate in all 50 states and offer free counseling and assistance to Medicare-eligible individuals, their families and caregivers. You can find the office closest to you with a search tool at shiphelp.org. The government tries to help reduce the complexity of Medicare choices with its star ratings of plans, but research has shown that high star ratings do not tell us whether a plan will improve our survival or not. This makes choosing a plan in Medicare very hard to understand and manage. It’s even harder for people who have dementia, or are in a nursing home, or both. All of this information means more work. But ensuring you’re properly protecting your health—and your pocketbook—is worth the effort. Amitabh Chandra is a professor of business administration at Harvard Business School and a professor of public policy and director of health-policy research at the Harvard Kennedy School of Government. He can be reached at reports@wsj.com. <end-snip>”
Well, the book may be/is hard to read/understand, but Medicare sure paid a large chunk of my two ER visits and hospital stays this past April. We've only had to pay like $300 for one of the doctors that seen me while I was in my hospital room. My Supplement also paid, but not nearly as much as Medicare did.
Agree. Both my wife and I had an unlucky health streak after retiring. It would have been financially devastating without insurance. She had metastatic breast cancer, 2 surgeries, chemotherapy, radiation therapy, lymphedema therapy, and she’s been on hormone therapy for almost 8 years and receiving infusions for bone mineral loss due to the hormones for about 2 years. She also had to have rotator cuff surgery immediately after and physical therapy. I had to have spinal surgery (2 level laminectomy). We both went through the rabies protocol because of bat exposure ($23,000 for the two of us). Out of all of that the only thing we had to pay for was a weird sling for her rotator cuff surgery. She has had to pay something for the hormone therapy pills but very reasonable. It would have drastically changed our lives without insurance. We have regular Medicare with UnitedHealthcare’s best (at the time) supplemental.