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Navigating the Unfathomable Complexities of Medicare

Photo by Money Care, LLC.

Photo by Money Care, LLC.

More than 95 percent of Americans aged 65 and older depend on Medicare for their health insurance coverage. With over 55 million people utilizing Medicare, you would think it would be simple to navigate. But, it is not.

“There can be little about Medicare that is automatic or clear or, especially in the midst of a medical emergency, logical or perhaps even fair,” says Philip Moeller in his new book, Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.

Moeller says it is unfortunate Medicare is so complex it requires a book about it. Medicare and Social Security staff don’t explain all the details (or don’t know them), and it is a challenge to find the information you need in its publications or online. Moeller’s book aims to explain and clarify the many rules, and help readers avoid costly mistakes while obtaining the health insurance coverage they need.

Most people don’t know Medicare’s rules, which could end up costing big bucks. Some of Moeller’s pointers are:

  • Medicare coverage does not happen automatically. You need to enroll. And, you enroll through Social Security, not Medicare.
  • Original Medicare pays only 80 percent of doctor, equipment, and other outpatient expenses. You pay the rest – forever. If you have a major medical event, this could be a lot of money.
  • Medicare only covers individuals. Couples need separate Medicare policies for each spouse.

The core of the book addresses what Moeller calls the “three big deals”:

  • Sign up at the right time and avoid penalties and the loss of coverage.
  • Choose from one of two Medicare paths: Original Medicare (with or without Medigap supplemental insurance) and a Part D drug plan, or, a Medicare Advantage plan, which usually comes with a Part D plan bundled in.
  • Understand what Medicare covers and how to get the most from whichever coverage path you choose.

Enrolling in Medicare at the right time is crucial. Miss a deadline and you end up paying potentially harsh penalties for life. Despite common perception, many people don’t enroll in Medicare at age 65. And, the circumstances under which you do or don’t need to enroll at age 65 are often unclear. Are you still working and are covered by an active employer group plan? Are you covered by COBRA? Are you moving to Medicare from insurance purchased on a state exchange? Each situation has different rules.

Moeller provides a valuable and in-depth explanation of Original Medicare (and all its parts), and Medicare Advantage plans: how they work, advantages and disadvantages of each, what they don’t cover, and how to evaluate and find plans.

The book has indispensable information for people already enrolled in Medicare. These topics include:

  • How to understand and evaluate the key aspects of your plans and how and when you can change plans.
  • How Medicare is financed
  • Premium subsidies available to low-income seniors and people with disabilities.
  • Your Medicare rights and how to handle complaints, appeal decisions, and address Medicare mistakes.
  • Numerous resources for help and more information (and how to find the information you need at those resources.

A medical insurance system so important to so many people shouldn’t be so complicated. Moeller says, “Navigating Medicare is challenging even to health care professionals who must deal with it every day. It is often unfathomable to the older and disabled people it is supposed to serve.” His book, Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, will help you or your loved one navigate Medicare’s foggy waters.

Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs by Philip Moeller is published by Simon & Schuster, and became available for sale in October 2016. Its list price is $19.99 USD.

This blog is published to provide you with general information only, and is not intended to provide specific or comprehensive advice.  Money Care, LLC encourages individuals to seek advice from competent professionals when appropriate. The names of the individuals in this article have been changed to protect their privacy.