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.
SOCIAL SECURITY – MEDICARE
This Web page from the Social Security Administration – which can also be downloaded as an electronic pamphlet in English or Spanish by clicking on the link at the top of the page – gives a more basic outline of Medicare than can be found on the other government Web sites, covering topics such as what Medicare is, who can get it, help for low-income people, and how to sign up.
SOCIAL SECURITY, MEDICARE & GOVERNMENT PENSIONS
Joseph Matthews and Dorothy Matthews Berman
Berkeley, California, 2009
This book provides a detailed guide to the entire Medicare program. Topics include how to enroll in Medicare, filing claims and appeals, Medigap supplemental insurance, Medicare Advantage plans, and low-income public aid programs.
THE COMPLETE IDIOT’S GUIDE TO SOCIAL SECURITY AND MEDICARE
New York, 2006
This book offers both information on, and tips for dealing with, Social Security and Medicare. The section on Medicare includes suggestions for how to pay for what Medicare doesn’t cover.
MEDICARE PRESCRIPTION DRUG COVERAGE FOR DUMMIES
Wiley Publishing, Inc.
Hoboken, New Jersey, 2008
This book painstakingly details the considerations that should go into choosing – or not choosing – a Medicare Part D prescription drug plan, as well as what to do once you’re enrolled. It includes worksheets to help the reader evaluate the program’s numerous offerings, tips for reducing drug costs, and ideas for finding outside sources of help.
Online tools and help
The Medicare Rights Center is a nonprofit organization that operates a consumer hotline (weekdays 9 AM to 5 PM EST, English and Spanish) to answer questions and help solve problems related to the program, including those related to payment denials and appeals, discrimination or mistreatment complaints, and financial difficulty resulting from bills. The organization also advocates policy changes that it believes would help Medicare beneficiaries. Visitors to the Web site can find general Medicare information, sign up for several e-mail newsletters, or learn about volunteering for the group.
This site, a service of the Medicare Rights Center, guides visitors to brief explanations of Medicare topics in response to either a keyword search or – if you don’t know quite what you’re looking for – a “Guide Me” feature that asks a series of questions. It also has a topic menu and an extensive glossary of Medicare-related terms.
This commercial site, operated by a publishing company, has basic information on Medicare as well as a Medicare Part D comparison tool in which individuals enter personal information, including what prescription drugs they take, to find out which plan available in their area is best for them. It is then possible to immediately apply for the plan online.
AARP INSURANCE & MEDICARE
This Web page has links to several Medicare-related articles and prominently features a “Doughnut Hole Calculator.” This tool asks you about your health plan, location, prescription drugs, and pharmacy to calculate whether you are likely to exhaust Part D prescription coverage and end up in the dreaded coverage gap, or “doughnut hole,” before catastrophic coverage kicks in.
MEDICARE MANAGED CARE APPEALS
This Web site, operated by the company that handles appeals for Medicare, has extensive information on the appeals process for claims rejected by Medicare or a Medicare-affiliated health plan.