How often do you think about your medical insurance coverage? If you work for an employer who has a decent plan that offers coverage for you and your family, the answer probably is - not very often.
Over the years, I was pretty much the same. I paid enough attention to know when open enrollment came around. That was about all. I was young, healthy, thought I was invincible and lived in an urban area with plenty of hospitals and doctor choices. There was little to figure out.
All that changed once I began caring for my elderly mother. Navigating all of Miss Nellie's medical affairs forced me to learn a much different insurance world.
What is Medicare? It is our country’s federal insurance health program. Medicare covers:
Those over 65
Some younger people with disabilities
Americans battling end-stage Renal Disease
Millions of Americans are covered by Medicare. From personal experience of handling mom’s insurance, I could see the coverage was thorough. Most every test, scan, lab x-ray or medical transport any doctor ordered was covered. Seriously - I saw some CRAZY HIGH fees!
I would look at the final bills and just shake my head. Don’t get me wrong, I loved my mother more than you can even know. But at age 87+, it seemed the countless tests, pokes and prodding were not going to make any difference or lead to improvement. No. It just put more money into the pockets of the medical teams.
While thousands of dollars were being paid out for mom's care through Medicare and a supplemental plan, the insurance plan under my employer refused to pay for an MRI which my doctor ordered for a painful wrist issue I was having. I'm young. Healthy. Lot's of living left. The test was deemed too expensive. Go figure...
But that’s the difference between private insurance plans and Medicare. And I believe that is exactly why many, including our elected leaders, cannot seem to agree on how Medicare should be adjusted.
President Biden and US lawmakers are currently haggling over proposals to expand what medical services are covered and for whom.
Various organizations are advocating to consider Medicare for All; not just those over 65. (After seeing the care my elderly, frail and not-going-to-recover mother received under Medicare, I can see the value in moving in that direction…)
In the meantime, there are some things you need to know.
If you or your elder whom you care for is approaching 65, it is time to begin educating yourself about Medicare and what coverage options you have in your area.
First, I urge you to visit Medicare.gov. You’ll see plenty of commercials on television working to get your business for care plans - but do a bit of homework first so you understand what is at stake.
Part A helps cover hospital insurance.
Part B helps cover medical insurance.
Part D is for prescription drugs.
And there are the supplemental insurance plans, often referred to as Medigap.
To help make sense of it all, AARP and many local Area Agencies on Aging routinely offer seminars and webinars reviewing the basics of how Medicare works. I urge you to sign up for one in your region.
When you turn 65 you are automatically eligible for Medicare coverage. You have seven months to make your decisions. The window starts three months BEFORE your 65th birthday and ends three months AFTER the month you turn 65.
This time frame is important. If you miss that window - for whatever reasons - you will typically have to wait for another enrollment period. That could lead to paying a penalty for NOT being signed up!
So that's your starter lesson for Medicare. It is much more involved than what we have covered here. But now the seed has been planted and hopefully you can see why it is crucial to start early.
Read. Educate yourselves. Prepare. And good luck!
Until next time~