Navigating the Medicare Maze

Navigating the Medicare Maze 

By Amy Rubino 

            That was one heck of a health care reform package providing a single system to cover millions, insurance that protects both individuals age 65 and older and younger disabled person, basic and extensive medical and hospital care, an annual premium of $110.50 per month and a program accepted by virtually all hospitals and most providers. Does something sound wrong? That is because we are not discussing the 2010 health care reform package, but rather the monumental passage of Medicare back in 1965!

          Reflect for a moment. Without Medicare, there would be no assurance that people over age 65 and people who are disabled would have health insurance. Reflect for another moment. People with Medicare typically have health issues. Statistically speaking, almost one-half of the people with Medicare have three or more chronic health conditions. Medicare has been the stalwart insurance program providing health insurance to our graying population for more than 45 years. Overwhelmingly, our nation strives to protect Medicare—any political mention of “cutting benefits” creates an imposing reverberation from voters.

          Yet while we venerate Medicare, we grumble as we wade through the mire to understanding the particulars of Medicare. We know it is vital that we make important decisions related to our Medicare, yet we feel defeated as bewilderment overtakes us. No doubt about it, Medicare is a massive program. With Medicare covering more than 47 million people, is it any wonder that we feel the odds stacked against us as we try to find the answers we need to make an informed choice?

          Medicare is a complex program. Medicare benefits range from Medicare Part A (hospital), Medicare Part B (medical), Medicare Part C (advantage plans), and Medicare Part D (prescription coverage). With all the facets of Medicare is it any wonder we feel overwhelmed by the overload? Medicare is managed by two federal agencies: eligibility is determined by the Social Security Administration, whereas Medicare benefits are regulated by the Centers for Medicare and Medicaid Services. Medicare advantage plans, Medicare supplement plans and Medicare Part D are sold by private companies.

          What is needed is a roadmap to successfully navigate the labyrinth of Medicare. We are well advised to begin learning about our Medicare at least three months prior to turning 65. One of the first steps is to contact Social Security to discuss enrollment in Medicare Part A and Medicare Part B. Social Security’s role, as related to Medicare, will be to (1) determine if you are eligible for Medicare Part A and B, (2) determine the premium costs for your Medicare and (3) enroll you into Medicare Parts A and/or B. Social Security does not answer questions about the benefits of Medicare, Medicare Part D, Medicare advantage plans and Medicare supplement plans.

          The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for administering the Medicare program. The website, www.medicare.gov is comprehensive and provides links to answer most Medicare questions. The website provides a tool to compare your options for Medicare Part D, Medicare advantage and supplement plans. There is also the option of calling the Medicare hotline at 800 633-4227 to talk directly with a customer service representative. The hotline is staffed 24 hours/seven days a week. CMS provides many publications free of charge. The principal publication, Medicare and You, is essential to a person who is new to Medicare.

          However, even with all the state-of-the-art hotlines and websites, there is still a time when we just need another person to help. But not just any person will do. We’re not sure we really trust sales agents since they have financial gain if we sign up. We want a knowledgeable, trustworthy person to answer our Medicare questions.

          Medicare provides grants to every state to provide a peer-mentoring service. The program is called the State Health Insurance Assistance Program (SHIP). SHIP relies on specially-trained volunteers who can help us understand our Medicare benefits and choices. SHIP counselors are unbiased; they do not sell insurance. Rather, SHIP counselors provide a person with the tools needed to make the important decisions related to Medicare.

          SHIP is a free service that is typically offered through the local area agency on aging. In Anne Arundel County, SHIP is offered at the Department of Aging and Disabilities. To make an appointment with an Anne Arundel County SHIP counselor, simply call 410 222-4464. If you live in another county in Maryland, call 800 243-3425 for your local SHIP program. If you, or a family member wants the SHIP program in another state, simply call 800 633-4227 for the correct contact number.

          Medicare decisions are vital. To sum up, allow adequate time to learn about your Medicare at least three months prior to becoming Medicare-eligible. Use the correct avenues to get the answers needed. Read Medicare and You, visit www.medicare.gov or call 800 633-4227. If there are still questions, ask your local SHIP program if they can assist. 

          Amy Rubino is SHIP director at the Anne Arundel County Department of Aging and Disabilities.

 

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