Understanding Medicare Coverage and What I Learned

Misunderstood Parts of Medicare Explained
Misunderstood Parts of Medicare Explained | Source

I recently turned 65 and became eligible for Medicare. So I dug deep into the rules and regulations, educating myself about Medicare and all its add-ons and penalties.

Researching and learning new things is second nature for me due to my background as a system analyst. And yet I found the experience with Medicare to be very stressful.

My intention with this article is to help you avoid the stress by giving you a decent understanding of the various parts of Medicare and the little-understood rules.

Once you have a good knowledge of the important issues you’ll be at a better advantage when it comes time for you to select the right coverage for your needs. You’ll also know how to avoid penalties that can become extreme for those who overlook the rules of Medicare.

I will not mention costs and premiums because it changes every year. That information is readily available elsewhere. It’s more important right now to give you a complete understanding of the overall makeup of Medicare. That’s what most people have trouble understanding.


Many Elderly People Don’t Understand Medicare


I discovered that many of my friends who are older than me, as well as their parents, ignored all this research and just took standard Medicare.

They discovered later the unexpected doctor bills that were not covered. They also found out too late about the irreversible penalties imposed for not starting certain additional coverage in time. I’ll get into those details in this article.

I have an advantage because as a computer programmer and systems analyst with a master’s degree, I have a knack for analyzing things and making sense out of it.

Many people tend to remain clueless. You’re already ahead of them since you are showing an interest by reading this article. I won’t let you down.


Age 65 - Time to make Medicare decisions
Age 65 - Time to make Medicare decisions | Source

So You’ll Soon Be 65


The saga began for me as I approached that all-important age of 65.

Everyone has different needs based on how healthy or unhealthy they may be, and differing financial situations as well. For that reason I can't tell you specifics with what to do. But I will tell you what I learned through my research and my reasoning with my decision-making to get the most out of Medicare.

That, without a doubt, should help you understand what you need to do and how to avoid the pitfalls.

When you are close to becoming 65 you will start getting a lot of mailings offering advice. These are agents who are focused on selling you insurance. They don't lie, but they don't tell you the full story either. They will only tell you what will convince you to go with their insurance.

I also started seeing a lot of Google ads everywhere I looked on the Internet. That's how Google advertising works. They know what your interests are, and what your needs are, based on your recent web browsing activity.

All these ads direct you to websites that help compare features of various plans.

It's best to ignore all these agents and ads. Everything they can tell you can also be found on one single most useful site: medicare.gov - and that is really the only place you need to visit when doing your research.

Take the time to scrutinize that site. It will save you from making costly mistakes.


Are Medicare Agents Helpful?


One thing I learned by doing my own research is that I kept stumbling upon agent websites that looked like they were specific insurance companies. Once I realized they are asking for personal contact information before I could gather any information from the site, I realized where I was.

Another thing I learned was that many agents I spoke with were giving me answers they knew I wanted to hear. After a while I realized they were doing this in an effort to get me to sign up with them.

It would be more honest if they were to give me specific reasons why one thing or the other is good or bad, rather than just tell me what's good.

Whenever I asked why something was not the right choice, they beat around the bush. As an example, when I questioned an agent working for Anthem about something that didn't make sense in their proposal, she said that I’d get a full document explaining benefits after I sign up and start being covered. What good is that? They lost my business for that reason.


The Alphabet Parts of Medicare


Medicare has different parts that cover different things. Original Medicare consists of Parts A and B.


Medicare Card Showing Active Coverage
Medicare Card Showing Active Coverage | Source

Part A: This is the part of Medicare that helps pay the cost of inpatient hospital care, including nursing services after leaving the hospital, hospice, and some other home health services. The Part A premium is paid by the government unless you earn over a certain amount. But for most people it’s free.

Part B: This is the part of Medicare that pays 80% of the cost of doctor services. You pay the Part B premium, but you can have it deducted form your Social Security if you’re already collecting it.

Part C: This is the part that confuses people. In my opinion this should not be listed as a part letter. It’s an optional replacement for regular Medicare known as an Advantage Plan. It’s handled by private insurance such as an HMO or PPO. It usually includes Part D (I’ll get into that later) for prescription drugs. And it may include other coverage not usually included with Medicare.

You have to pay extra for this, but in some states all or part of the premium is paid by the state. Advantage plans cover the other 20% that Medicare doesn’t cover. They replace the entire thing with one insurance, although you still have to pay for Part B if you want an Advantage Plan. But you carry just one Insurance card and you can still have your Part B premium deducted from your social security benefits.

I found out that my doctor was not in any of the advantage plans I looked at. That’s a problem you need to check closely. Your doctors have to be registered with each particular HMO or PPO, otherwise you will get billed extra for those doctor visits.

Supplemental Plans (not a Part): In my opinion this should be called Part E for Extra. You have the option of adding a supplemental plan instead of going with an advantage plan. This is also known as Medigap insurance just to confuse you. All Supplemental plans cover the other 20% and you can go to any doctor that accepts Medicare.


Part D Prescription Drug Coverage
Part D Prescription Drug Coverage | Source

Part D: This is prescription drug coverage. It’s optional, but accumulates penalties if you don’t take it. It covers medications with a lot of loopholes. If I were to get into the details, it would cover an entire additional article. So I’ll just let you know the terrible bad news about this here.

If you are healthy and don’t need medications, except once in a blue moon when you come down with a cold or have an injury that needs medication, you might think that you can pass up on Part D and save the cost of the monthly premium.

The problem is that for every month you go without Part D, and if you don’t have any other creditable prescription drug coverage (see next section below), then you’ll have a 1% penalty per month added onto your premium in the future when you do end up taking a Part D plan.

Just to be clear, that’s 1% of the national average cost of Part D for every month you delay starting from the month you become 65. So, for example, you decide you need drug coverage when you’re 70. That’s 60 months since you were 65. So you’ll have a 60% penalty added to your premium.

Think about that! Nobody does. Nobody complains to his or her congressmen about this. We all vote for our politicians without realizing how we are being screwed. So our politicians are free to abide by the only people telling them what to do – the drug companies.


What is Creditable Prescription Drug Coverage?


A creditable prescription drug plan is one that qualifies for Medicare to avoid the penalties I mentioned above. Any plan that is specified as Part D by the insurance company is a creditable plan.

You may also be covered by insurance from a current or former employer, union, or even a spouse’s insurance that is considered a creditable prescription drug plan. Make sure you get a letter indicating that it is creditable coverage. You’ll need that letter to avoid penalties if you join a Part D plan later.


Original Medicare vs. Advantage Plans

Original Medicare
Advantage Plan
Part A - Hospital
Part A - Hospital
Part B - Medical/Doctors
Part B - Medical/Doctors
Part D - Prescription Drugs
Part D - Prescription Drugs
Supplemental (MediGap)
Possible Extras
A Supplemental Plan is an optional add on to regular Medicare to cover the other 20%. Advantage Plans usually include Part D and may also include additional extra coverage.

Is Medicare Void of Obamacare Regulations?


Here’s an interesting note: I began my Medicare in the middle of 2015, and my rates already went up 20% in January of 2016 for the Part D drug coverage. I thought that I'd get away from Obamacare now that I became of age for Medicare. But the Affordable Care Act (Obamacare) screwed with Medicare too.


“Part of the agreement of the Affordable Care Act is that Medicare cannot negotiate lower drug prices with pharmaceuticals.”

— Dr. Sanjay Gupta http://www.cnn.com/profiles/sanjay-gupta-profile

Quick Review: Covering Your 20% Share Medicare Does not Pay


Medicare only cover 80% of your doctor bills. And what’s worse, they don’t cover excessive charges that some doctors bill beyond Medicare approved amounts. If you want to have insurance that pays your 20% share, you can do this with either of two methods:

1. Supplemental (Medigap) insurance. Private insurance companies provide this. You keep your Original Medicare Parts A and B. The Supplemental plan pays some of the costs not covered by Original Medicare.

2. Advantage Plans. There are many varieties that cover different things. This completely replaces Original Medicare and rolls all coverage into one plan known as Part C. A lot of research needs to be done to select the right one for your situation. The most important thing is to check if your doctors are in the plan you choose.

I like Supplemental (Medigap) plans better because any doctor who accepts Medicare will be covered. Advantage plans require you to use doctors and hospitals in their network. Supplemental Plans do not have networks, so you can use any doctor or hospital that accepts Medicare.

Based on your own needs, Advantage Plans can be a reasonable choice. You just have to compare and know what you’re getting.

Of course you can just go with Parts A and B without additional coverage, but you have to pay the other 20% of doctor bills in that case.


Regular Medicare Travels With You


Regular Medicare and all Supplemental Plans protect you when you travel anywhere within the U.S. You may visit any doctor or hospital that accepts Medicare patients. This includes specialists who accept Medicare with no need for referrals.

This is not true with Part C Advantage plans since private insurance companies run these. You’ll need to check their specific rules.


Video: Review of Medicare

Choosing to Just Use Parts A and B Without Extra Protection


As a healthy person I feel I can deal with paying the 20% Medicare doesn't cover. But if I wait 6 months and add a Supplemental plan or Advantage Plan later, they can charge me more, refuse preexisting conditions, or turn me down altogether. Obamacare specifically left Medicare out of the preexisting condition rule. Not many people realize that.

Then there's Part D for prescription drugs. I don't need it now, but as I explained earlier, they tag on a 12% penalty every year that I wait (1% per month). And that would stay with me the rest of my life.

Medicare is soooo cruel. They get you coming and going. And they take advantage of the elderly who can't sit and read and study and make decisions for themselves.


There is a Medigap Supplemental Plan That’s Right For You


When you are covered by a Supplemental Plan (Medigap), there are no surprises. You’ll know exactly what’s covered based on the plan you choose.

Don't confuse plans with parts. Medicare has Parts A, B and D. And supplemental coverage has several plans to choose from, labeled from Plan A through Plan F. Rather than duplicate that info here, you can see a complete detailed listing of each plan at medicare.gov. Remember, that’s the only site you need for all your questions.

By law, each plan is exactly the same no matter which insurance company you go with. So once you decide on the supplemental plan you want, the only thing you need to compare is the cost.


Medicare Part B Excessive Charges


When you see a doctor who doesn’t “accept assignment,” that means he or she doesn’t accept Medicare’s approved amount as payment in full.

You need to pay this in addition to your 20% share. But only up to 15% more than Medicare’s approved amount. The doctor does need to forfeit the rest. But it still is an additional cost to you that you may not be expecting.

Supplemental Plan F covers all of this, your 20% plus any excessive charges. Plan N covers your 20% but not excessive charges.


Why can't supplemental premiums be taken from social security?


Only Advantage Plan and Part D Prescription Drug Plan premiums can optionally be deducted from Social Security benefit payments because both of these are primary insurances.

Supplemental Insurance is considered a secondary insurance and therefore its premium cannot be deducted from Social Security.

With Medicare Part B, you actually have a choice. You can pay for it yourself in quarterly installments or you can have it deducted from your monthly Social Security benefits if you are already collecting.


When Do You Need to Start Extra Coverage to Avoid Penalties?


Remember that Medicare Parts A and B do not cover everything.

Basically Part A covers hospital costs up to 150 days. But you still share part of those cost, and you pay all the costs after 150 days.

Part B only pays 80% of doctor bills. You are responsible for the rest, including deductibles and excessive charges.

So, you may want to consider adding a supplemental plan to regular Medicare, or replacing it with an Advantage Plan, also known as Part C. I know. That’s so confusing. They should never have called it Part C. It really is a total replacement of Medicare that simply includes Parts A, B and D.

Anyway, keep in mind that there are penalties for delaying extra coverage.

You must sign up for a Supplemental Plan or Advantage Plan within six months of your 65th birthday month. This is your one-time Initial Enrollment Period. However, if you begin Part B later because you had insurance from an employer or a spouse, then this six-month period starts when you begin Part B.


Is it true that supplemental plans can be changed anytime throughout the year?


One can apply for Supplemental Insurance without penalty during the Initial Enrollment Period, which is within 6 months of the 65th birthday month.

Supplemental Plans can be started or switched from one plan to another at anytime. But penalties may apply if started or changed AFTER the Initial Enrollment Period.

Penalties include:

  1. Higher premium.
  2. Waiting period before covered.
  3. Refusal based on medical conditions.

These Penalties do not apply during the Initial Enrollment Period.

Advantage plans can only be changed annually. But Medicare Supplemental Plans can be changed anytime. However, penalties may be imposed when you make changes, such as higher premiums or refusal to accept preexisting conditions. These penalties can also stand in the way if you try to apply after the open enrollment period.

One last thing, it’s important to know that if you start with a Medicare Supplemental plan and change your mind and switch to an Advantage Plan, you may not be allowed to switch back to regular Medicare. So be careful with Advantage Plans. (Reference “Medicare & You 2106” page 103)


What is the Open Enrollment Period?


Once a year, from Oct 15th to Dec 7th, one can change, join or drop Advantage Plans. This does not apply to Supplemental Plans, however, which can be changed anytime with restrictions as I mentioned above.


What is the Special Enrollment Period?


You thought I was done. But there’s one more. If you move and your present Advantage Plan does not cover you at the new location, you can change your insurance within a Special Enrollment Period.

Note that Supplemental Plans cover you all over the United States, so this only is necessary to consider if you have an Advantage Plan.


Doing your Own Due Diligence


As extensive as you may have found this article, I only gave you the important information that most people have trouble understanding. I know because since I started with Medicare, a lot of people have been asking me for help.

So I hope this has helped you have a good understanding with a thorough background of information to help get you started in the right direction.

You will have to do you own research since no one can tell you what’s best for your particular situation. Only you know that.

Just remember that as you delve into it, ask questions and be curious. That’s what I did.


© 2016 Glenn Stok

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Comments 36 comments

moonlake profile image

moonlake 8 months ago from America

The problem we ran into with Medicare was it wouldn't pay for a medical test that should have been done. For example, my husband had lung cancer. He should have had a brain scan and some chemo for his brain just to make sure and catch cancer before it did go to his brain. The doctors were going to do that but Medicare wouldn't pay for it.

The lung cancer did go to his brain and that is what he died from.

Medicare is hard to deal with and I know your hub will help a lot of people understand it.


Austinstar profile image

Austinstar 8 months ago from Somewhere in the universe

Thank you for this hub. I have pretty much figured this out on my own, but it took a while and I do feel sorry for people that do not know how to do their research. But of course, there is just too much confusing information out there for people who are elderly and not web savvy.

My biggest issue with Advantage plans is the stupid way they run things. Their member web sites are extremely unhelpful and they continue to send snail mail letters for EVERY claim, every inquiry, every bit of information (handbooks, etc.)! I have a huge box full of Private Health Info that they insist on sending through the mail.

And if you call their customer service lines, it's 10 minutes of legal mumbo jumbo before you can even ask a question. And then the human you get to talk to doesn't have a clue about how to be helpful.

I can only hope I live long enough to see National Health Care like in Canada or Europe.

I hate insurance companies! I have worked in the health care field for over 30 years and I have watched them destroy the health care industry.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

moonlake - What a shame. Sorry to hear about your husband. That's one of the problems with Medicare. It's not as good as private insurance. But private insurance costs much more.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

Austinstar - Yes! I went through the same crazy things when I researched several Advantage Plans. They each sent me a really thick notebook with all their mumbo jumbo. Each was around 200 pages. I decided if they put so much money into printing these books, there wouldn't be anything left to pay the claims. So that was a big red flag too.

And I also had the experience you had when calling. One agent from Anthem Blue Cross couldn't answer me over the phone and she told me I'd get my answer in print after I sign up. What good is that!


moonlake profile image

moonlake 8 months ago from America

We did have private insurance. If Medicare doesn't cover it our insurance wouldn't cover it. The only thing they did cover was Hospice they covered that without Medicare.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

moonlake - It's really unfortunate how complex the rules are, especially when they cancel one another out just to benefit the insurance companies.


Austinstar profile image

Austinstar 8 months ago from Somewhere in the universe

This year, i wanted to change ins. Companies and i asked my doctor of 15 years which insurance she would be a member of for 2016. She gave me her list and i signed up with blue cross blue shield of texas. Now they are telling me that she is not part of their hmo and they assigned me a pcp that i had never heard of. 5 phone calls and several letters later they still have not straightened this out. My doctor has even called them. They keep saying she is not taking new patients or their software is disallowing me to have her as my pcp. Ive told them today to fix it or i will drop them. Weird thing is that when i signed up, it let me choose her as my pcp. Then they switched it saying she wasnt in their network, but she is. I just want to scream.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

Austinstar - Back when I first started with Obamacare (before my Medicare kicked in) I had selected Blue Cross on the ACA site and I actually had the same experience as you are describing you're having with Blue Cross's Advantage Plan. So I'm not surprised. Three times I tried to select a PCP and a month later they removed him. I ended up getting my premium back in a dispute where I claimed they never really insured me all that time since they kept removing the PCP from their database. It's troubling to see that Blue Cross still never fixed that problem since 2014.

I'm glad I got away from them. And with Medicare I chose not to use them either, especially since their agent refused to answer my questions as I mentioned in this article. I found out later they only answer questions that are positive. Anything that can lose a sale, they play dumb. I'm seeing a pattern here. Thanks for your info on your experience.


MsDora profile image

MsDora 8 months ago from The Caribbean

Very helpful. I was shocked to find that there were penalties for not accepting some benefits later than at the start. I'm paying for benefits I can never use here where I am, but just in case . . . New subscribers should this useful.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

MsDora - You're not the only one. Many people miss that requirement. I have a friend who never took Part D prescription drug coverage. I kept telling him about the penalty. He didn't believe me. Now he needs drug insurance so he started Part D and discovered he has a $62 penalty added to his monthly premium for waiting so long.


MizBejabbers profile image

MizBejabbers 8 months ago from Arkansas

Glen, Medicare is the biggest mess I've ever seen. I'm still working at way past Medicare age, but I've carried Part A since I was 66. When my state employees insurance became rife with ridiculous copays and deductibles, I decided to drop it and get Parts B and D. We will see how that works out this year. I must say that I got a good agent who helped me through this. I learned that my state is a participant in Part G, that must be bought within 6 mos. of Part B. It has a small ($150 deductible -- my private insurance ded. was $500) but otherwise has the same benefits as Part F, and the premiums are about 30% lower. My Plan D prescription coverage went down by $10 mo. this year.

My husband has an Advantage plan because he is also a VA patient and this covers things the VA won't do, like his total knee replacement. Anyhow, he wasn't eligible for Part G because he went on SS disability many years ago. We have a really good agent who puts her clients before her commission. She recommended an Advantage plan with no premium, but we rejected that for one with a $30 premium because it had prescription drug coverage and some other benefits the VA didn't provide. So, I think whether or not you are happy with Medicare depends on which state the person lives in. I'm afraid our new governor Republican governor is going to wreck the good organization of Obamacare authored by our former governor.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

MizBejabbers - Thanks for that detailed info. I do have to correct a few things you said just so other readers don't get confused. Medicare has "Parts" but Supplemental Plans have "Plans". You were confusing parts and plans.

Plan F is the best Supplemental Plan, but the most costly too. It's best because you will never get a bill - they cover everything. I chose Plan N which is one step down. It saves $100 a month in premium and the only thing I need to watch for is those doctors who have excessive charges. Plan F and Plan G both cover excessive charges. The other Plans do not. You have Plan G in your area, which only has a low $150 deductible. It's good when you can get it, depending on your location.

When you mentioned Plan D, you really meant Part D for prescription drugs.

Sorry for correcting you but I need to be sure others don't get confused. It's confusing enough already, especially when people don't notice the difference between Medicare Parts and Various Plans available under Supplemental Insurance. Parts and Plans, Oh my!


denise.w.anderson profile image

denise.w.anderson 8 months ago from Bismarck, North Dakota

Thanks, Glenn, for sharing this information with us. We are getting closer to this time ourselves, and may have the situation where we will have employer based insurance when my husband turns age 65. Does one qualify for Medicare at the same time as they qualify for Social Security, or are there two different ages involved here?


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

denise.w.anderson - Medicare starts when you are 65. Presently the Social Security full retirement age is 66. But you can start sooner or delay it. The longer you wait you get more monthly. But delaying may not be a good idea since the Social Security Trust Fund will be exhausted by 2037 unless changes are made financially. They tell you this in your annual statement, but most people never read those messages.


MizBejabbers profile image

MizBejabbers 8 months ago from Arkansas

Glen, you are so correct, I did interchange "Part" and "Plan". That's what I get for replying so close to lunch. Thanks for correcting my blunder. However, as far as Plan G and Plan F go, I think it may depend on your medical needs. Plan G in my state costs me $126 a month and Plan F premium is $166 unless they went up this year. That's a savings of $40 per month or $480 a year for me. I pay a $149 deductible but everything else is exactly the same. so Plan G saves me $480 - $149 = $331 per year. therefore with my medical needs, I can't say that Plan F would be the best plan for me. I don't believe G is offered in every state, and it isn't offered in every county in my state. I don't know why the discrimination. Again, thanks for catching my blunder because I surely didn't.


UnnamedHarald profile image

UnnamedHarald 8 months ago from Cedar Rapids, Iowa

This is by far the best, clearest overview of the choices one faces when nearing age 65 I have ever read. While I am more than a year away from my 65th birthday, I have gone through this with my wife. We chose original Medicare with supplemental/Plan F and a drug plan during her enrollment period. While supplemental premiums have increased each year, the increases have been extremely moderate for the healthcare industry and based on age (so far). The drug plan we chose has increased premiums from $31 a month to $61 over a three year period, causing us to choose a different drug plan which looks like it's better and cheaper. We utilized our state's Senior Health Insurance Information Program (SHIIP) to help us wend our way through Medicare choices, but articles like yours are a great foundation. I heartily recommend utilizing your state's SHIIP when making Medicare (and SS) decisions. And I thoroughly agree that non-governmental sources of information are biased (and that's being kind). I was NOT aware that switching supplemental plans (even during the annual window) was not simply a matter of switching but having to be accepted. That, I find disturbing, but I will almost certainly not put myself in the hands of an Advantage Plan. All I have to add is that our experience so far with Medicare has been very good so far. Again, two thumbs up for this fantastic article.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

MizBejabbers - You explained all that really well. I would like to have taken Plan G myself, but it's not available where I am. So that's why I took Plan N instead. I don't feel I need the total security of Plan F. If someone has a lot of illnesses then Plan F would be the right choice so that they never have to worry about getting any bills, other than the insurance premiums.

As I am sure you know, all plans are the same everywhere. Plan G is Plan G no matter where one is. Plan F is Plan F, and so on. The only thing that varies from one insurance company to another is the premium. So the premiums you quoted may be different for other people selecting the same plan elsewhere.

Advantage Plans are a completely different animal. They can be totally different since they are independent of Medicare. I just want to let other readers know that this discussion here was in relation to Supplemental Plans.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

UnnamedHarald - Thank you so very much for those kind words and your validation of my article. The drug plans have been rising, as you discovered, mainly because the ACA included a ruling that Medicare cannot negotiate with drug companies for better prices. Hopefully that may change if we ever have a president who doesn't accept contributions from lobbyists such as the pharmaceutical industry.

As for possible issues with preexisting conditions and higher premiums if one switches plans, I had to do a lot of research on that to be sure. I included that information based on confirmation when I called and spoke to an rep at Medicare.

It's worse when you switch to an Advantage Plan and then change your mind and want to switch back to original Medicare. You can get turned down. These are things people need to know before making drastic changes. Many people just stick with original Medicare and never run into these problems, So that's why you don't hear much complaint about this.


FlourishAnyway profile image

FlourishAnyway 8 months ago from USA

I learned a lot from this. I never knew what the A, B, C & D stood for and I sure didn't know about the impact of that penalty on D. Your example was crystal clear.


Glenn Stok profile image

Glenn Stok 8 months ago from Long Island, NY Author

FlourishAnyway - Thanks for letting me know my hub was crystal clear, as you said. That's what motivated me to write this. Ever since I studied the Medicare rules, a lot of friends and acquaintances have asked me to clarify the convoluted instructions that Medicare provides in their literature. People tell me I have the ability to clarify things because of my logic and programming background. It's always nice to hear that confirmed.


Paul Kuehn profile image

Paul Kuehn 6 months ago from Udorn City, Thailand

Glenn, Thank you very much for a very informative article. I am retired living in Thailand and am covered by Blue Cross-Blue Shield with my federal employee plan. At the present I am only covered with Part A of Medicare. I will definitely check out the medicare.gov website. I am sharing this hub with HP followers.


Glenn Stok profile image

Glenn Stok 6 months ago from Long Island, NY Author

Paul Kuehn - That's interesting. I don't know about how Medicare applies to US citizens living in Thailand. Hopefully you'll find the information you're looking for. Part B is important to cover visits to doctors. Thanks for sharing.


vocalcoach profile image

vocalcoach 5 months ago from Nashville Tn.

Hi Glenn

I'm gluing your hub to my cell phone, computer and even the bathroom walls :) I discovered a whole new level of stress dealing with medicare. I'm going through a situation right now with coverage for my meds for diabetes and thyroid. I can no longer pay the outrageous fees for these drugs and may have to stop them altogether. The system sucks!

What a terrific hub! Will share everywhere.

Audrey


Glenn Stok profile image

Glenn Stok 5 months ago from Long Island, NY Author

vocalcoach - Wow! I didn't realize I'd make such a powerful impression. Thanks for your sharing, Audrey. Sorry to hear you're going through so much trouble with the cost of your meds. I also found it stressful analyzing everything about Medicare when I first signed up. That's what motivated me to write this hub. Thanks again for your positive feedback.


bgigstead profile image

bgigstead 5 months ago

Glenn, Sorry about the link. Anyway as I had mentioned, I am a Independent Licensed Medicare and Individual/Family Health Agent, currently licensed in 42 states. There are important cost factors to look at with Original Medicare Part A and B. For 2016 Part A has a $1288 deductible per benefit period. A benefit period starts the day you go into a hospital and ends 60 days after you leave the hospital. If you are readmitted into a hospital within 60 days for the same reason as the prior visit or on day 61, you are subject to a new deductible. Thus you can be responsible for multiple deductibles through the year.

Part B has a $166 deductible for 2016 and the biggest thing to look at is there is no maximum expense, so if you have a $100,000 medical bill you will owe $20,000.

Medicare Supplements and Medicare Advantage plans can help with those numbers. Medicare Supplements, with the certain riders or plans, require only the premium thus a plan with a $150 per month premium, your total expense would be $1800 for the year, even with a $100,000 medical charge.

Medicare Advantage have an Out of Pocket Maximum which limits your total expense to that limit regardless of the total medical charge. Out of Pocket Maximums can rage from $3000 - $6700, at least from the plans I have seen. The insurance company picks up the rest.

My advice is to work with an Independent Agent who works with all the plans in your area for the most unbiased recommendations.


Jean Bakula profile image

Jean Bakula 3 months ago from New Jersey

Hi Glenn,

This is a really helpful hub. I was widowed two years ago, and also have several health problems, and had tried to go on disability several times. I was finally able to get SS at 60, but didn't know much about Medicare, as both my parents died young and I didn't have to deal with it. I found the people at 1-800-medicare to be very helpful. Since I was already on SS, they had my info on file, no matter who I spoke with.

I had a cataract on my eye last year, before I got Medicare, and had to pay for most of it out of pocket. Now the other eye has one, so I did get Part C, just in case, because friends have told me eye problems are hard to get covered. I don't want to get stuck again. They surely could make the process easier.


Glenn Stok profile image

Glenn Stok 3 months ago from Long Island, NY Author

Jean, Part C is an advantage plan. You need to be sure your ophthalmologist is signed up with the one you chose and that they cover cataract surgery. Sorry for the loss of your husband two years ago.


Paul Kuehn profile image

Paul Kuehn 3 months ago from Udorn City, Thailand

While visiting the States in June of 2016, I met with a Medicare rep in the city near where my sister lives. I found out that because I live overseas I am not able to get any of the Medicare services available in the States. The reason for this is due to billing as the agent explained. As a veteran, however, I can get VA medical benefits while living overseas.


Glenn Stok profile image

Glenn Stok 3 months ago from Long Island, NY Author

Paul Kuehn - Thank you for sharing that information about overseas limitations with Medicare.


Jean Bakula profile image

Jean Bakula 3 months ago from New Jersey

Thanks for your kind words, my life has changed a lot. Especially in the health insurance area. When my husband first passed, his company paid my COBRA for 6 months, and then we split it 50/50 the rest of the year. We had been together for 39 yrs. and the company loved him. Then I had to get BC/BS of NJ, and it was really a ripoff, I paid almost $800.00 monthly, and it was going up to $1,000.00 monthly if I didn't get on Medicare a little younger than most. My ophthalmologist is on Plan C. I also always get weird, hard to diagnose illnesses, which usually sends me on a whirlwind of specialists, so I thought it best to just get everything. I'm still paying half of what I would have been if I hadn't gone on Medicare, so it works for me.


Glenn Stok profile image

Glenn Stok 3 months ago from Long Island, NY Author

Jean Bakula - If you are having constant medical issues and you find yourself paying half the bills, you may want to look into switching from your advantage plan (Part C) to a supplemental plan. Specifically, Plan F will cover all your bills and you'll never get a bill from doctors or hospitals. Just the monthly premium for plan F. With a supplemental plan, any doctor that accepts Medicare will be covered. You'll have to compare the premium cost to your present medical costs to see if that works for you any better.


Jean Bakula profile image

Jean Bakula 3 months ago from New Jersey

Thanks, I'll check out plan F. That isn't something I recall reading about at the time I was deciding what plans to get.

But since I have been on Medicare, beginning Jan 1st of this year, I'm paying so much less. So it is getting better.


Todd Elzey profile image

Todd Elzey 4 weeks ago from Phelps, NY

Mr. Stok: This is a very good article, but I would like to point out two things that you might wish to consider adding. First, in addition to being available to those 65 and over, Medicare is also available to those who are permanently disabled (according to Social Security Criteria), and who have received Social Security Disability benefits for 24 months.

Second, I worked as a Medicare Appeal Officer for Maximus Federal Services for 8 years from 2006-2014. In that job I adjudicated somewhere in the neighborhood of 10,000 Medicare Advantage (Part C) enrollee appeals. And I can say with certainty that Medicare Advantage Plans do not always cover the 20% coinsurance that is part of Medicare Part B coverage. In fact, the plans very widely nationwide. Some plans really aren't much more than what is covered with the exact same 80%/20% cost sharing structure as original Medicare (Parts A & B), while other plans cover almost everything with absolutely no cost sharing for the enrollee at all. And of course there is a lot of variation between these two extremes. Consequently, it is essential that individuals considering enrolling in a Medicare Advantage (Part C) plan look at the actual Evidence of Coverage documents for the plans they are considering to fully understand what is covered and what the cost sharing is for the covered services. By the way, the plan documents are required to be available on the Plan's website and any agent who tells a potential enrollee that they can't get the documents until they have signed up is violating Federal regulations and can be reported to CMS. I believe Medicare still considers it a type of Medicare marketing fraud. Thanks again for your article, and I hope these comments are helpful.


Glenn Stok profile image

Glenn Stok 4 weeks ago from Long Island, NY Author

Todd Elzey - Thank you Todd. Since you have been a Medicare Appeal Officer you definitely are an authority on this and I appreciate the time you took to add this information.

Advantage plans are very different from one another, unlike standard Medicare. I find them quite unclear what they actually cover. I even talked about how one agent failed to give clear answers when I asked about a particular Advantage plan, as you had noticed in my article. This is why I personally chose a supplemental plan instead. Thanks for adding that I could have reported that agent, and also for your other useful info in your comment.


norlawrence profile image

norlawrence 4 weeks ago from California

Very good article Glenn. I am fighting Medicare with Mike who has Heart and Lung problems. He now is in stage 3 Kidney disease which they say was brought on by medications. It is kind of like if the disease do not kill you the cure will. He has a supplement insurance so everything is going pretty well so far. His drug program went from 29.00 a month to 71.00. There are some drugs they will not pay for so there is the problem of finding a drug that will do the job that they will pay for. Thanks for article. Your supplied some great information.


Glenn Stok profile image

Glenn Stok 4 weeks ago from Long Island, NY Author

norlawrence - It's good he has a Supplimental plan and Part D for the medications. It's true that Part D does not cover all medications very well. This is because Obama signed a bill not allowing insurance companies to negotiate lower drug prices. As long as we have a system of government where drug companies can lobby the politicians and get what they want, Medicare will never be a perfect solution. Sorry to hear about Mike. I wish him well.

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