Table of Contents
Introduction xiii
Medicare Is a Mystery: It Doesn't Have to Be xiii
Why Is Medicare So Important? xv
Why Is Medicare So Confusing? xvi
How to Use This Book xviii
Avoid Mistake #1 xx
Very Brief History of Medicare xxii
Ignoring Medicare Noise Is Difficult xxiii
Chapter 1 Enrollment 1
Medicare Eligibility 2
Signing Up for Medicare 3
Can I Delay Enrollment in Medicare? 5
Late Enrollment Penalties 7
Medicaid 9
Conclusions: Thinking Ahead Is Key 10
Chapter 2 Medicare Part A 11
Eligibility 12
If You Don't Qualify 13
Part A Benefits 13
Key Term: Benefit Period 16
No Annual Out-of-Pocket Limit 18
Chapter 3 Medicare Part B 21
Premium 21
Annual Deductible 22
Coinsurance 23
Part B Coverage 23
Coverage Details 24
Sources of Part B Confusion 27
Canceling Medicare Part B 31
No Annual Out-of-Pocket Limit 31
Chapter 4 Prescription Drug Coverage 33
The Basics 34
Eligibility 34
Enrollment 35
Prescription Drug Plan Terms 36
The Standard Part D Plan 37
The Complicated Calculations Involved in Part D 38
Why People Misunderstand the Coverage Gap 39
How to Choose 40
Important Hints on Using the Medicare Plan Finder 41
Preferred Pharmacies and Mail Order 42
Changing Plans 43
Important Extras 43
Chapter 5 Medicare Advantage 47
The Basics 47
Types of Medicare Advantage Plans 49
Medicare Advantage Prescription Drug Plans 52
Enrollment 53
Medicare Advantage Annual Enrollment Period 55
Medicare Advantage Twelve-Month Trial Right 55
Open Enrollment Period 55
How to Choose 59
How to Compare Medicare Advantage Plans 60
Medicare Advantage Has Improved 63
Consumers Must Understand Networks 64
Surprise Medical Bills 65
Medicare Advantage Extras 66
Medicare and Medicaid 67
Extra Help and Medicare Advantage 68
Snowbirds 68
Foreign Travel 69
Chapter 6 Medigap 71
Medigap Enrollment 72
Medigap Coverage 75
Medigap and Medicare Part A 76
Medigap and Medicare Part B 76
Premiums 78
Advantages of Medigap 79
Switching to Medigap 86
Switching from Medicare Advantage to Medigap 88
Special Topics 88
The Bottom Lines 92
Chapter 7 Working beyond Sixty-Five 95
People Are Working Longer 95
Small Employer 97
Base Case: Medicare Is Superior 98
Large Employer 100
Employer Group Plans and the Coverage Gap ("Donut Hole") 103
If You Decide to Cancel 105
The Bottom Line 105
Chapter 8 Retiree Benefit Plans 107
Retirement from a Small Employer 108
Retirement from a Large Employer 109
The Base Case 110
Medicare Retiree and Non-Medicare Spouse 112
Retiree and Medicare-Eligible Spouse 113
If Your Employer Cancels Retiree Health Benefits 113
Employer-Sponsored Medicare Advantage 114
Dental, Vision, and Other Benefits 115
What Employers Can Do 116
Conclusions 116
Chapter 9 Special Groups 119
Veterans Administration (VA) 119
TRICARE for Life (TFL) 121
Disabled 122
Disabled and Employer-Sponsored Plan 123
ESRD and COBRA or Employer-Sponsored Plan 123
Federal Employee Health Benefits (FEHB) 124
State and Local Government Employees 125
Educators 127
Unions 127
Hospital (and Other Health-Care Employees) 128
Small Business Owners 129
Professional "Associations" 130
Seriously III 131
Conclusions 134
Chapter 10 The Savvy Medicare Consumer 135
Stay Focused on the Goal 135
Dealing with Medicare Problems 136
Professionals, Amateurs, and Advertisements 140
Last Tips 143
Experts' Addendum 145
Insurance Is an Option 145
Health Insurance Is Different 146
Options Are Priced Using Probability 146
Everyone Is "Short" an Option 148
Sources of Volatility 149
Comparing Apples to Apples 150
Medigap vs. Medicare Advantage Revisited 151
Our National Long-Term Care Problem 153
Insurance-Based Solutions Exist 153
Long-Term Care Insurance 154
Life Insurance Basics 155
Life Insurance and Living Benefits 156
Annuity-Based Solutions 157
These Options Are Difficult to Analyze 157
Glossary 159
Endnotes 170
Acknowledgments 181
About the Author 183
Index 184
