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Navigating Healthcare

Submitted By Diane L Marolla, LICSW, MarollaConsultants@yahoo.com

“You know, for most seniors Medicare is their only form of health care. “ Corrine Brown

On July 30, 1965, President Lyndon Johnson established Medicare. Thankfully, our politicians at that time had the foresight that our seniors needed health insurance. The “Original Medicare” as it is called was established (Medicare Parts A&B).

Since the time of passage, Medicare, over the years has been expanded to provide more coverage. In my opinion the coverage is still not comprehensive enough as there are gaps in coverage. Additionally, Medicare is confusing specific to which parts, cover what, deductibles, the rules (i.e. skilled care versus custodial care), and the need for supplemental coverage. I recall, 25 years ago, when my mother was terminally ill, despite having what was called “double coverage” (commercial insurance as my father was still working and Medicare), it still wasn’t enough coverage to pay all the bills from her doctor’s and the hospital.

Since we are approaching open enrollment season for Medicare (October 15-December 7), I thought I would review the “basics” of Medicare.

Components of Medicare

Part A-Hospital insurance directly through the Federal government
Part B-outpatient services through the Federal government
Part C- Medicare Advantage Plans (medical and prescription coverage) offered through health insurance
companies
Part D-prescription coverage

Because parts A,B,C&D do not offer 100% payment for services, you may find it necessary to purchase supplement insurance to ensure more comprehensive coverage. Known once as “Medigap insurance” the supplement plans are labeled A,B,DF, F with a High Deductible, G,K,L,M,N. Are you confused yet because I am. As I write this article, I am hoping by the time I have Medicare, that it might be simpler (wishful thinking I’m sure).

Please be aware that if you do purchase a supplemental plan, the agent selling the plan to you must abide by certain rules to protect you.

Remember, Medicare is health insurance coverage for only “medically necessary services for a skilled facility or home health care”. Medicare will not cover you for long term care in a nursing home. Also, Medicare does not cover dental or eye exams.

In a nutshell, whether you are new to Medicare, renewing your existing policy, or changing your policy, it is a decision that you should not make without doing your homework. One should not rely on recommendations of friends and family who are not familiar with Medicare or the complex rules. Medicare coverage unfortunately is complicated.

Should you need guidance in making your decision, contact The Rhode Island Senior Health Insurance Program (SHIP). SHIP counselors are volunteers who are well rehearsed on the topic of Medicare. They can provide unbiased counseling to you so that you can make an informed decision. To get a complete list of the SHIP agencies you can call 401-462-0510 or go on line at www.dea.ri.gov/insurance

To prepare for your decision, medicare.gov is an excellent, user-friendly website that can assist you with “all things Medicare”.