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Introduction

For most people, turning 65 or otherwise becoming eligible for Medicare feels like stepping into alien territory without a map. The signposts you think should be there often aren’t immediately visible. When you ask for directions, you can’t always be sure you’re being pointed down the right path.

Medicare For Dummies, 4th Edition, is the map you need. It gives accurate, practical information about Medicare in plain language. It shows you how to skirt pitfalls and avoid wrong turns that can cost you dearly. My goal is to help you make informed, confident decisions that take you where you want to be. How can I promise that? Because this book is, in essence, the result of thousands of questions I’ve received over the years from people just like you.

I know from many of those questions that people eligible for Medicare often receive incorrect information from sources — such as government officials — they should be able to trust. That’s why, in these pages, I not only give you information that’s firmly based in law but sometimes also identify certain specific regulations (by name, number, and website) that you can use if you need to prove to an official the legal authority for a particular point about eligibility, enrollment, late penalties, and so on. You can’t find these useful references, which I offer as a kind of consumer empowerment, in other guides.

Confusion about Medicare is almost inevitable for two main reasons. Its regulations apply to different people in different ways, according to their specific circumstances, so the decisions you need to make may be unlike the next person’s. Also, it offers an array of choices that can be bewildering if you don’t know how to sift through them to get to the one that’s right for you.

So think of your Medicare card as your passport into the terrain of guaranteed health care, where you’re welcome regardless of income or pre-existing medical conditions, but you still have to find your way around. And consider this book the road map that helps you navigate the highways and some of the more obscure byways of that system and keeps you on track.

About This Book

This fourth edition of Medicare For Dummies provides information that was accurate at the time of going to press. But the administration and Congress have announced proposals for radically changing three of the major programs described in this book — the Affordable Care Act (Obamacare), Medicaid, and Medicare itself. At the time of this writing, none of these proposals have passed into law. And in the case of Medicare, any major change to the program wouldn’t take place for several years and wouldn’t affect people older than 55 at the time it goes into effect.

Therefore, in the chapters that follow, you find out what you need to know to get through the Medicare maze right now and get the most out of your coverage. You find answers to some questions that are barely addressed — and sometimes not touched upon at all — in official consumer publications about the program. You discover where to turn for additional help, if you need it. And, as in any For Dummies book, you can easily locate and understand the specific information you’re looking for because of the reader-friendly organization and straightforward language.

As you may expect from a program run partly by a federal bureaucracy and partly by private insurance plans, you’re going to meet some unavoidable jargon in this book. These terms are worth getting to know because notices you get from the government or the plans — or any to-and-fros you have with either — will be easier to understand. So I use the following conventions:

 I explain new terms in Medicare-speak the first time they appear in the text. They’re also defined in the glossary in Appendix B.

 When you see the word Medicare used on its own, it usually means the whole Medicare program (as in “When you join Medicare …”). Sometimes it means the federal agency that runs Medicare (as in “Medicare may send you a notice …”). The agency’s official name, the Centers for Medicare & Medicaid Services (CMS), appears as the source of information in some tables.

 I typically refer to the basic Medicare program (Part A plus Part B) as “traditional Medicare.” I call the private plans that comprise the alternative Part C program “Medicare Advantage plans” or “Medicare health plans.”

 I use the terms Part D and Medicare drug coverage interchangeably to discuss the Medicare prescription drug program. I refer to the plans that provide this coverage as “Part D plans” or “Medicare drug plans.”

Feel free to skip anything marked with the Technical Stuff icon as well as the sidebars — those chunks of text that appear in shaded boxes. They’re not necessary to understanding how to find your way through Medicare. Still, you may find them interesting. Ever wonder how on earth Congress dreamed up some of the more oddball bits of this program? You can find the answers in sidebars scattered throughout this book.

Within this book, you may note that some web addresses break across two lines of text. If you’re reading this book in print and want to visit one of these web pages, simply key in the address exactly as it’s noted in the text, as though the line break doesn’t exist. If you’re reading this text as an e-book, you’ve got it easy — just click the address to be taken directly to the page.

Foolish Assumptions

This book assumes that you don’t have any working knowledge of Medicare — really, none at all! But even if you do, you can still find practical insights and useful tips to help you navigate the system more quickly, easily, and confidently. If you recognize yourself in any of the following scenarios, you can find help in these pages:

 Your 65th birthday is on the horizon or coming up fast, and you realize you know nothing about Medicare or how to get it.

 You’re younger than 65 but will soon qualify for Medicare as a result of disability and need to know how it works for you.

 You intend to continue working beyond 65 in a job that provides health insurance, and you aren’t sure whether you should join Medicare.

 You have good retiree health benefits from a former employer and wonder how they fit in with Medicare or whether you even need it.

 You live outside the United States and want to know about Medicare enrollment and coverage rules — whether you’re an American abroad or an immigrant.

 You’re already enrolled in Medicare but can use some help to troubleshoot problems, find a better deal, or reduce your expenses.

 You need a crash course on Medicare issues because you’re helping a parent, relative, or friend navigate the system.

 In your job or volunteer time working with seniors or people with disabilities, you can use a plain-language reference to Medicare.

Another point: This book assumes no political standpoints. Medicare has always been a controversial hot potato, gingerly tossed between those who think of it as a social safety net that should be extended to everyone and those who see it as an expensive luxury that is a growing drain on the economy. If you hold strong opinions, fine; that’s your privilege. But in these pages, the only “us versus them” undertone is a bias toward consumers (us) rather than politicians, government bureaucracies, and insurance companies (them). The aim of this book is to help you understand and deal with the system as it is now. If you want it changed — or don’t want it changed — please tell your members of Congress, not me!

Icons Used in This Book

Icons are those cute drawings you see in the page margins now and again. Here’s what they mean.

This icon signals important information. If you take anything away from this book, it should be information highlighted with this icon.

This icon draws your attention to on-target advice and practical insights that will save you time, effort, and maybe even money.

This icon raises a red flag to alert you to a Medicare rule or potential pitfall that may trip you up if you remain blithely unaware of it.

This icon points out information that’s interesting but not crucial to understanding the ins and outs of Medicare.

Beyond the Book

In addition to the material in the print or e-book you’re reading right now, this product also comes with some access-anywhere goodies on the web. For important Medicare dos and don’ts, pointers on enrolling in Medicare at the right time, and key sources of Medicare help, go to www.dummies.com and type “Medicare For Dummies Cheat Sheet” in the Search box.

Where to Go from Here

Nobody expects you to read this book cover to cover. It’s not a thriller or a bodice-ripper! But it does act as a plain-language reference to a program that millions of people use but few understand. So you can jump in anywhere to the bit you need, at whatever point you happen to be when grappling with Medicare. For example:

 Want to know how Medicare works? Start with Part 1 to see what Medicare covers, how much it costs, and how you can lower expenses.

 Don’t know when you should sign up or how to go about it? Chapters 6 and 7 show you the way, according to your circumstances.

 Need to make a choice among Medicare’s many options and private plans? Find out how to do so in Chapters 9, 10, 11, and 12.

 Want to get the best out of your Medicare coverage and avoid pitfalls? You’ll find lots of pointers in Part 4.