MEDICARE SURVIVAL GUIDE

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