Medicare

If you are age 65 or older, legally disabled, or have end-stage renal disease, you are eligible for Medicare health insurance. If you have a chronic illness that requires taking expensive medications, it’s especially important to understand Medicare Parts C and D to make sure you get the best coverage possible. This is what Global Healthy Living Foundation Patient Advocate Yvonne B. does every year.

What is Medicare?

Medicare is a national health insurance program for people who are 65 years and older, on social security disability benefits or have certain conditions like end-stage renal disease and amyotrophic lateral sclerosis. The program is administered by the U.S. federal agency, Centers for Medicare and Medicaid Services (CMS).

Understanding Medicare Parts

Medicare Part A and B

Parts A and B are traditional Medicare health insurance administered by the federal government. Part A is hospital insurance and Part B is medical and outpatient hospital insurance. Almost everyone in Medicare opts for this traditional coverage.

If you have Part A you can also sign up for Part B by paying an extra premium. Even though Part B is optional, if you don’t enroll in Part B when you become eligible, you may be charged a late enrollment penalty fee.

Medicare Part C and D

Parts C is Medicare Advantage and Part D is prescription drug coverage. These are managed by private insurers instead of the federal government.

You can have Part D if you have the traditional coverage of Parts A and B. Usually Part C (Medicare Advantage) provides prescription drug coverage, so you rarely need Part D coverage if you have Medicare Advantage.

For more information on Medicare parts click here.

How do I sign up for Medicare?

If you are interested in Medicare, check out this eligibility calculator to see if you can join.

If you are eligible, Sign up for Medicare at www.socialsecurity.gov and begin a new application. You should sign up three months before your 65th birthday.

1. Educate yourself before you apply or are automatically enrolled so you know which Medicare plans work best for you.

2. Get your questions answered before you apply, especially in particular about the management of your chronic illness. Educate yourself so you know which Medicare plans work best for you.

Visit the Medicare website at medicare.gov.

Patient Real-Life Lesson: Yvonne’s Story

Yvonne B., Maryland

Despite living with migraine disease and being recently diagnosed with rheumatoid arthritis, Yvonne is an active and resilient health advocate who donates her time to such causes as CreakyJoints, Poor Peoples Campaign, and Miles for Migraine. Enrolled in Medicare, Yvonne often faces significant hurdles in accessing the medications her doctors prescribe. Many require prior authorization, despite there being no generic equivalent. Delays in treatments are worrisome and, even worse, some medications are not covered by Medicare Part D, which creates additional out-of-pocket costs. So before Yvonne selects her drug coverage plan annually, she’s learned that it’s valuable to consult a list of all of her medications and compare it with the formularies available in different Medicare Part D plans, so she can pick the plan that gives her the best coverage and minimizes her out-of-pocket costs. Click on the link below to learn more about formularies for Medicare and other important things to consider while choosing a health insurance.

How to Pick a Health Insurance Plan

There are a few important things to consider when choosing a health insurance plan that is right for you, especially if you are living with a chronic illness.

Find out the different parts of Medicare available. There are four parts of Medicare insurance.

Find out what information you need before applying for insurance. Make sure you have all of this information before you start in order to make this process as fast as possible.

Find out if your medication is covered. Each health insurance plan has a list of covered drugs, known as a formulary. Read our step-by-step instructions on how to find out if your prescription is on a plan’s formulary.

Find out what out-of-pocket costs you’re responsible for. Your health insurance plan’s deductible, copayment, coinsurance, and out-of-pocket maximum determine how much you will end up paying for care. Learn more about each of these factors.

Learn about the various financial assistance programs available. If you have a private insurance plan through Medicare Part C or D or in addition to Medicare, there are several ways that you can find financial assistance to help cover your out-of-pocket costs.

Find out if you should expect a delay in getting your prescription. Find out if your medication requires prior authorization. If it does, your healthcare provider must fax a request to the insurance company for approval before you can pick it up from the pharmacy.

Avoid plans with a copay accumulator adjuster program. These programs, which can be found in some health insurance plans, do not allow copay cards to go towards your final deductible. Learn more about copay accumulator adjuster programs.

Have a complaint about your health insurance company? Learn more about the role of Insurance Commissioners and learn how to file a complaint.