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 xxi
Very Brief History of Medicare xxii
Ignoring Medicare Noise Is Difficult xxiv
Chapter 1 Enrollment 1
Medicare Eligibility 2
Signing Up for Medicare 3
Can I Delay Enrollment in Medicare? 5
Late Enrollment Penalties 8
Medicaid 10
Conclusions: Thinking Ahead Is Key 11
Chapter 2 Medicare Part A 13
Eligibility 14
If You Don't Qualify 15
Part A Benefits 15
Key Term: Benefit Period 18
No Annual Out-of-Pocket Limit 20
Chapter 3 Medicare Part B 23
Premium 23
Annual Deductible 24
Coinsurance 25
Part B Coverage 25
Coverage Details 26
Sources of Part B Confusion 29
Canceling Medicare Part B 33
No Annual Out-of-Pocket Limit 34
Chapter 4 Prescription Drug Coverage 35
The Basics 36
Eligibility 36
Enrollment 37
Prescription Drug Plan Terms 38
The Standard Part D Plan 39
The Complicated Calculations Involved in Part D 40
Why People Misunderstand the Coverage Gap 41
How to Choose 42
Important Hints on Using the Medicare Plan Finder 43
Preferred Pharmacies and Mail Order 44
Changing Plans 45
Important Extras 45
Chapter 5 Medicare Advantage 49
The Basics 49
Types of Medicare Advantage Plans 50
Medicare Advantage Prescription Drug Plans 54
Enrollment 55
Annual Election Period 57
Medicare Advantage Twelve-Month Trial Right 57
Open Enrollment Period 57
How to Choose 61
How to Compare Medicare Advantage Plans 62
Medicare Advantage Has Improved 65
Consumers Must Understand Networks 66
Surprise Medical Bills 67
Medicare Advantage Extras 68
Medicare and Medicaid 70
Extra Help and Medicare Advantage 70
Snowbirds 71
Foreign Travel 72
Chapter 6 Medigap 73
Medigap Enrollment 74
Medigap Coverage 77
Medigap and Medicare Part A 78
Medigap and Medicare Part B 79
Premiums 80
Advantages of Medigap 81
Switching to Medigap 88
Switching from Medicare Advantage to Medigap 90
Special Topics 91
The Bottom Lines 94
Chapter 7 Working beyond Sixty-Five 97
People Are Working Longer 97
Small Employer 100
Base Case: Medicare Is Superior 100
Large Employer 102
Employer Group Plans and the Coverage Gap ("Donut Hole") 106
If You Decide to Cancel 107
The Bottom Line 108
Chapter 8 Retiree Benefit Plans 109
Retirement from a Small Employer 110
Retirement from a Large Employer 111
The Base Case 112
Medicare Retiree and Non-Medicare Spouse 114
Retiree and Medicare-Eligible Spouse 115
If Your Employer Cancels Retiree Health Benefits 115
Employer-Sponsored Medicare Advantage 117
Dental, Vision, and Other Benefits 117
What Employers Can Do 118
Conclusions 118
Chapter 9 Special Groups 121
Veterans Administration (VA) 121
CHAMPA and TRICARE for Life (TFL) 123
Disabled 124
Disabled and Employer-Sponsored Plan 125
ESRD and COBRA or Employer-Sponsored Plan 125
Federal Employee Health Benefits (FEHB) 126
State and Local Government Employees 127
Educators 129
Unions 129
Hospital (and Other Health-Care Employees) 130
Small Business Owners 131
Professional "Associations" 132
Seriously III 133
Conclusions 136
Chapter 10 The Savvy Medicare Consumer 137
Putting it All Together Isn't Easy 137
Ignore the Noise 138
Dealing with Medicare Problems 139
Professionals, Amateurs, and Advertisements 144
Last Tips 147
Experts' Addendum 151
Insurance is an Option 151
Health Insurance Is Different 152
Options Are Priced Using Probability 152
Everyone Is "Short" an Option 154
Sources of Volatility 155
Changes to the Medicare System 155
Comparing Apples to Apples 156
Medigap vs. Medicare Advantage Revisited 157
Our National Long-Term Care Problem 159
Insurance-Based Solutions Exist 159
Long-Term Care Insurance 160
Life insurance Basics 161
Life Insurance and Living Benefits 162
Annuity-Based Solutions 163
These Options Are Difficult to Analyze 163
Glossary 165
Endnotes 176
Acknowledgments 188
About the Author 191
Index 192
