Tips to Making the Most of Your Medicare Coverage

Medicare is health insurance for people 65 years old and older, those under 65 suffering from certain disabilities and those of any age with End-Stage Renal Disease (ESRD).

If you get to learn about the extensive benefits that Medicare offers, you will find that it gives you sufficient coverage for your health needs. In a nutshell, it provides for hospital insurance, medical insurance and prescription drug coverage. Problems with Medicare often crop up because of a lack of thorough understanding about the system.

Here are some tips to prevent that and help you make the most of your Medicare coverage:

1. Make sure that you will have Medicare coverage in the first place. If you have paid Medicare taxes while you were still working through Social Security, you are covered for Medicare Part A and B. Those who don’t have Social Security can still enroll in both but will have to pay the necessary premiums. For 2011, the cost of premiums each month if you purchase Part A on your own is $450. The cost of your premium for Part B depends on your annual income-it’s $115.40 for individuals receiving $85,000 or less yearly.

2. Get the right coverage. You can select to enroll under an Original Medicare or Medicare Advantage Plans which you can get from HMOs or PPOs. If you feel that Original Medicare will suffice for your health care needs, then that’s fine. A more thorough coverage can be provided by a Medicare Advantage Plan, also known as Plan C, under HMOs or PPOs. However, these types of HMO policies also have their own pricing, premiums and policies, so make sure that you figure these in your monthly budget. They have their own governing rules as well so certain exclusions and limitations on the providers you can go to for care also vary with each HMO. Thus, it’s important to know the specifics of a specific policy before locking yourself into one.

3. Make sure that you enroll for Part B since enrollment here is not automatic. There are cases when you can delay enrollment, such as when your current employer insurance is primary to Medicare (in cases when you or your spouse is still working and you get coverage through the employer). However, you should still enroll as soon as you or your spouse stops working. Failure to enroll in Part B could mean gaps in your Medicare coverage. If you sign up late, you will also be subject to penalties.

4. Sign up for Part D or a Prescription Drug Plan, especially if you are on prescription medication. Prescription Drug Plans are usually bundled with Medicare Advantage plans so there’s no need for it when you have HMO or PPO policies tied with Medicare. In selecting a drug plan, understand the quantity limits, the premiums and deductibles and if it covers the drugs you are currently taking.

5. If Medicare or HMO refuses to cover treatment or services, make it a point to appeal. There are cases when this happens, so be ready. You have the right to appeal under these circumstances.

Last but not least, don’t forget to look at this wonderful web site about insurance for seniors and this post on health insurance for seniors.