If you are age 65 or older, chances are you are enrolled in Medicare. This public program is the largest health insurance provider in the United States, with more than 45 million beneficiaries. For most, eligibility is based on age, but people who have disabilities that prevent them from working or who have another qualifying condition such as end-stage kidney disease are also eligible for coverage.
Medicare has existed since 1965 and has undergone several major changes over the years — in 2006, for instance, a prescription drug benefit was added. Currently, Medicare has four parts: Part A, public hospital insurance; Part B, public medical insurance; Part C, privately operated plans that can be chosen instead of parts A and B (called Medicare Advantage plans); and Part D, privately operated prescription drug coverage for those who want it and do not receive it through Part C.
The recent changes to the Medicare program, as well as the numerous plan options enrollees must choose from, can make using Medicare complex. And, as with any health insurance plan, problems can arise after enrollment that may require fighting for a claim or filing a complaint. This list of resources provides a variety of tools for learning about Medicare, finding out what options are best for you, and advocating for yourself within the system.
(800) MEDICARE (633-4227)
TTY: (877) 486-2048
Medicare has a 24-hour phone service with both English- and Spanish-speaking representatives. Callers can obtain general information, get answers about any Medicare-related topic, or order official Medicare pamphlets and publications (which are also available for download from the Web site).
Medicare’s Web site has several very useful features, many of which are accessible through the toolbar on the left side of the home page. A good place to start is “Medicare & You 2009,” an electronic pamphlet in PDF format that is available in both English and Spanish (for the Spanish version of any electronic pamphlet on the site, type “_s” in your Web browser before the “.pdf” ending that shows up for the English version). This pamphlet covers nuts-and-bolts Medicare basics, including recent changes in the program. Since it is sent each year to everyone enrolled in Medicare, you may already have a paper copy.
By clicking on the “Am I Eligible?” tab of the Web site, visitors are led through a series of questions to determine their current or future eligibility for Medicare services. Or for the most simple overview of Medicare choices, click the tab called “Plan Choices.” “Preventive Services” lists recommended screening tests and other services, with information on exactly what Medicare will pay for. If you have a detailed question about Medicare, try the “FAQs” link found at the top of almost every page on the Web site.
Some especially useful pamphlets available from the Medicare Web site are “Choosing a Medigap Policy” (www.medicare.gov/publications/pubs/pdf/02110.pdf), which discusses private insurance options to supplement Medicare, and “Are You Up-To-Date on Your Preventive Services?” (www.medicare.gov/publications/pubs/pdf/11420.pdf), a handy checklist.
CENTERS FOR MEDICARE & MEDICAID SERVICES
This Web site has some of the same information as the official Medicare site in a no-frills format; it also goes into greater detail on many topics and includes others not found on the official site (such as those most likely to interest doctors and health-care providers). Sections include General Information, Appeals and Grievances, Coverage, Eligibility and Enrollment, Health Plans, and Prescription Drug Coverage.