Understanding Medicare

To say it's confusing is an understatement


You’ve likely seen that TV ad with former NFL quarterback Joe Namath, the one where he assures you that all it takes to get no-cost, no-worries, full Medicare coverage stacked with free perks and benefits is a simple phone call to a toll-free number.

Though Namath may have famously guaranteed his New York Jets would upset the heavily favored Baltimore Colts in Super Bowl III in 1969, these days his advice as the paid pitchman for a private, for-profit lead generator is no sure bet.

“If you’re attracted by the Joe Namath commercials that say, ‘We’ll give you a zero premium and then we’re going to add all this other free stuff on to it,’ well, there is no free lunch,” says Dan Alcorn, who grew up in Nashua and is a nationally certified Medicare plan specialist, licensed agent and the principal of D.J. Alcorn & Associates headquartered near Albany, New York.

“When you call that 800 number, you’ll just get a telemarketer on the other end of the line. I want people to make informed decisions,” adds Alcorn.

Easier said than done. Much easier.

Medicare, currently covering 61 million Americans, is a federal health insurance program for people aged 65 and older and for some younger people who receive Social Security disability benefits. It sounds straightforward enough.

But navigating the Medicare maze is oftentimes arduous at best. Not only are the rules and restrictions bewildering because they’re different for people in different circumstances — and can even be different for spouses — but you can easily drown in what’s known as the alphabet soup.

“What gets people confused is the A, B, C, D of the Medicare parts, and then what makes it even more confusing is the Medicare supplement plans F, G and N,” says Alcorn. The G and F plans, he explains, have high deductibles, and people understandably confuse them with parts A through D.

“I don’t know who came up with all these terms, but yikes,” he says. “It is mind-boggling. I only work in the Medicare space. It’s just so complicated that I focus only on this one thing,” says Alcorn, who has more than 40 years of experience in financial services.

Trying to understand Medicare is so overwhelming that tomes are written on the subject. The US Department of Health and Human Services publishes and distributes, free of charge, the 120-page book “Medicare & You” annually. On its website (aarp.org) the AARP has dozens of articles and links to help decipher all the ins and outs of the program. An updated “Medicare for Dummies” by Patricia Barry will be released and available for sale on November 3. It is the fourth edition and contains a colossal 408 pages.

To cut through all the chaos, Alcorn teaches a free “Medicare 101” webinar each month via his website, dgalcorn.com. Along with deeper dives into the minutiae of Medicare, Alcorn offers lots of handy information and guides to assist newcomers, like this list of eight things to get the most out of your trip to the doctor:

1. Ask Questions. Doctors suggest writing out a list of questions before your visit to ensure that you remember them. Write the questions in order of importance in case you can’t get to everything.

2. Mind the Time. Stay focused on why you’re in the office. We all like a little chit-chat and doctors like to know what’s going on in our lives, but if you only get 10 minutes, then minimize the small talk. Call ahead if you’re running a few minutes late and minimize your waiting time by booking appointments first thing in the morning.

3. Bring your Meds. That includes herbal and over-the-counter medications, and prescriptions you might have gotten from another doctor. Bring the bottles with the original label so you can double-check the dosing and make sure there hasn’t been an error.

4. Take Notes. Writing down what the doctor says could help jog your memory after the visit.

5. Tell the Truth. Even uncomfortable topics, such as poor eating habits, medication adherence or risky practices might cause you to avoid or sugarcoat a subject, but don’t leave things out. If you’re not being truthful, the doctor can’t do their best job in taking care of you.

6. Bring a Friend. Going to an appointment accompanied by a spouse, an adult child or a friend is particularly important if you’re expecting important test results. You may have trouble understanding or remembering things, and having someone else there can help with that.

7. Be Realistic. Having a hard time getting more exercise like the doctor told you to, or having trouble changing your diet? Don’t feel embarrassed to ask a question if you don’t understand something.

8. Bring the Important Things Up First. When you’re having a health concern that provokes some anxiety, you may need to work up the nerve to ask about it, but don’t save it to the end of the visit. Then you’ll have the least time to discuss it. Having a prioritized list of what you want to discuss with the doctor can help with this. 

The Basic Do’s and Don’ts of Medicare

Medicare coverage is available to anyone aged 65 or older who has worked at least 10 years in the United States, but there is no simple explanation of how it all works. To help cut through the chaos, Patricia Barry has written two companion books, “Medicare for Dummies” and “Medicare Prescription Drug Coverage for Dummies.” Here are some do’s and don’ts from the author, and free information can also be had from the federal government at medicare.gov or (800) 633-4227.

• Do give yourself plenty of time to get informed about the many different plan choices and deadlines.

• Don’t expect to be notified when to sign up unless you’re already receiving Social Security benefits. Be proactive.

• Do enroll before the deadlines to avoid permanent late penalties.

• Don’t worry that poor health or preexisting conditions will deny you coverage or make you pay higher premiums. They can’t.

• Do realize that this program isn’t free. You pay premiums and are responsible for certain copays.

• Don’t assume Medicare pays for everything. There is a wide range of coverage, but there are gaps and that’s why you need to buy a Medicare Advantage or a Medicare Supplement plan.

Categories: Seniors