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Medicare & You 2012: Navigating the New Healthcare Options

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As recipients quickly find out upon navigating Medicare options, the choices available are both good and bad--and all options should be considered before choosing. While these plans are designed to match an individual’s healthcare needs and budget, in

If you’re 65 years or older (or have certain disabilities) and live in the United States or its territories, you are qualified to receive Medicare, a national social insurance program administered by the United States government, enacted by Lyndon B. Johnson as part of the Social Security Act of 1965.

As individuals new to this system become aware, like most other health insurance, Medicare does not cover all your healthcare costs. There are co-payments, deductibles, and premiums involved, and Medicare does not cover long-term care.

The good news is that Seniors have many options--you just need to be mindful of the best Medicare program for your specific needs.

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For most everyday needs as well as treatment for more serious illness and injury, there are two primary Medicare programs: traditional Medicare, and Medicare Advantage. Once you know which kinds of medical services you are likely to need, choosing between the two programs gets easier (as outlined in the Medicare & You handbook readily available). Here’s how the coverage options break down:

Medicare Parts A and B

If you collect Social Security or have a Railroad Retirement Board (RRB) pension, then you will automatically receive Medicare Part A and Part B (unless you decline coverage) which covers hospital stays and routine medical care and treatment you normally receive from your doctor. There is, however, a premium for Part B.

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If you are 65 years or older and do not collect Social Security or RRB, you may very likely be eligible for Medicare Parts A and B--you just have to sign up. (You must sign up three months before your 65th birthday or up to three months after to avoid delays and additional paperwork. If you sign beforehand, your coverage will begin on the first day of the month of your 65th birthday.) The rules are somewhat different if you become disabled or are “active-duty” military or military retiree, which you can learn about at www.medicare.gov.

In that Medicare Parts A and B do not cover long-term care or in-home nursing, many beneficiaries opt for private insurers that can take up this slack.

Medicare Part C

Also referred to as Medicare Advantage, Medicare Part C provides for individuals who prefer managed care like one might received under an employer’s health insurance program. Medicare Part C providers are private insurance companies contracted by the US government to provide healthcare for enrolled Seniors and provide some cost-savings not available through traditional Medicare.

While individuals are required to use doctors and hospitals signed up with the program, since most employer programs are also designed this way, most Seniors have little difficulty adjusting. However, you should be aware that the provider you presently have may not be among those Medicare approved, so you’ll want to verify their association.

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According to healthcare professionals, the big difference between traditional Medicare and Medicare Advantage is in the “extras.” 

Some providers offer free gym memberships, lower co-pays, and the convenience of having all your medical records in a common network that all providers can readily access. Since Medicare Advantage providers vary by state, you’ll want to visit the medicare.gov webpage to check out you options.

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If you are already signed up for Medicare Parts A and B, between Oct 15 and Dec 7, you can switch to any Medicare Advantage provider. After Dec 8, you can switch to any five-star provider at any time. (If you are enrolled in Medicare Part C and want to switch back to Parts A and B, you can do so between Jan 1 and Feb 14, 2012.

Medicare Part D

If your healthcare regime entails a number of prescriptions or costly prescriptions (and you do not have private prescription coverage), then Medicare Part D may be your best option. Like Parts A and B or C, however, there are premiums and co-payments involved. Thus for some individuals, utilizing one of the many state or county prescription help programs typically offered across the country is an even better option. Healthcare experts suggest talking with your doctor about such options before committing to Part D.

Overview

As recipients quickly find out upon navigating Medicare options, the choices available are both good and bad--and all options should be considered before choosing. While these plans are designed to match an individual’s healthcare needs and budget, in that these choices are the result of a lot of companies vying for your business (often, for many years), they are part of a system designed to make money.  Therefore, they may not voluntarily provide you the best path to take; leaving you to be discerning and do your homework.

To best accomplish this, individuals are urged to analyze their monthly costs, read all available literature (including the Medicare & You handbook), and explore every option. Be prepared to change plans if your medical needs are not being met or you are not happy with your provider. And should the choice process seem daunting, consider asking relatives or friends for help.  It’s imperative that you make an informed decision that will sustain your medical and healthcare needs.

References:

www.medicare.gov/find-a-plan/questions/home.aspx

Senior Voice America, Oct issue

Medicare & You, 2012

Images via Wikipedia.org unless credited otherwise

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James R. Coffey
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James R. Coffey

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