This book focus on the basics of Medicare, what each part covers, when to enroll, and how to utilize the insurance benefits. The writters delve into the “promise vs. reality” of coverage, issues with utilization, and how to aggressively fight to maximize your insurance benefits so they don’t turn out to be worthless. They explain inpatient vs. outpatient criteria, “admitted” vs. “observation status,” what questions to ask to save thousands of out-of-pocket costs, and ways to become a better patient advocate.
Summary of Contents
Understanding Medicare: A Primer for the Medicare System
- What Is Medicare
- Medicare Coverage
- Medicare’s Components
- Medicare Part A Covered Services
- Medicare Part B Covered Services
- Part B Covered Preventive Services
- What Medicare Does Not Cover
- Enrolling in Medicare
- Cost Sharing
- Part A Premiums
- In-Patient Hospital Care
- Medicare Part A Costs: Paying for Inpatient Hospital Stays
- Part A Benefit Period
- Skilled Nursing Facility Care
- Medicare Part A Costs: Paying for Skilled Nursing Facility
- Hospice Care under Medicare Part A
- Hospital Inpatient vs Outpatient Status
- The Effects of Outpatient Status
- Medicare Part B Premiums
- Medicare Part B Deductible
- Medicare Part B Costs Beneficiary Pays
- Enhancing Basis Medicare Coverage
- Medigap Plans (Supplemental Insurance for Parts A and B)
- Medicare Part C (Advantage Plans)
- Medicare Part D (Prescription Drug Coverage)
- Medicare Enrollment Options
- Medigaps
- Medigap Benefit Matrix
- Medicare Advantage Plans
- HMO
- PPO
- SNP
- PFFS
- MSA
- When You Can Join or Switch Advantage Plans
- Medicare Part D
- Standard Part D Plan Cost Characteristics
- Medicare Prescription Drug Plan
- Coverage Through the “Donut Hole”
- Formulary
- When You Can Join or Switch Medicare Prescription Drug Plans
- Medicare Part B Drugs
- Integrating Medicare and Medicaid Coverage
- Pennsylvania’s Dual Eligibles
- Dual-Eligible Coverage – Medicare’s Part
- Dual-Eligible Coverage – Medicaid’s Part
- Community HealthChoices (CHC)
- Dual-Eligible Coverage – Prescription Drug Assistance
- Appendix: Medicare Basics (Slides)