Medicare For The Clueless: The Complete Guide to This Federal Program

Medicare For The Clueless: The Complete Guide to This Federal Program

by Joan H. Conklin

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Overview

For the more than 39 million people currently on Medicare and the million plus who join each year, navigating the murky rules and regulations of health care coverage can be a full-time job. Not anymore. For ten years, Joan Harkins Conklin has guided people through the Medicare maze, and in this straightforward, comprehensive manual, she'll show you how to sail through the Medicare bureaucracy to access the benefits you need and deserve. Getting doctor bills and hospital accounts paid quickly, making important decisions, knowing your rights, demanding refunds -- it's all here in the only reference that outlines the steps you and your family can take to optimize the program to your benefit. Written by an expert who fully understands the real-life difficulties in dealing with the health care system, Medicare for the Clueless debunks the myths, lays out the facts, and provides clear, efficient steps that put the power of Medicare in your own hands.

Product Details

ISBN-13: 9780806523163
Publisher: Penguin Random House LLC
Publication date: 06/01/2002
Series: The Clueless Guides Series
Pages: 228
Product dimensions: 5.50(w) x 8.50(h) x 0.52(d)

Table of Contents

Forewordxi
Introductionxiii
Chapter 1Getting Started1
What Is Medicare?1
What Does It Cover?1
Who Is Eligible?2
How Much Does It Cost?3
How Do You Enroll?4
Where Do You Enroll?5
When Should You Enroll?5
Recap7
The Medicare Card9
Getting Help to Pay Your Health Care Costs: The Medicare Savings Programs9
Chapter 2Medicare Part A13
Hospital Bills13
The Deductible14
Benefit Periods17
Psychiatric Hospital Restrictions18
Chapter 3What You Should Know Before You Enter the Hospital19
Medicare Myths19
Your Rights as a Medicare patient19
Advance Directives23
Care in a Foreign Hospital24
Paying Hospital Bills26
Chapter 4Skilled Nursing Facilities31
When Medicare Pays31
What Part of the Bills Does Medicare Pay?32
Notice of Noncoverage35
Looking for a Nursing Home37
Chapter 5Home Health Care38
When Medicare Pays: The Rules38
What Medicare Covers40
What Medicare Does Not Cover40
Your Rights41
Advance Directives42
How to Find an Approved Home Health Care Agency42
Home Health Care Advance Beneficiary Notice43
Chapter 6Hospice Care46
Who Is Eligible?46
How the Program Works47
What Is Covered?47
Deductibles and Copayments48
Chapter 7Doctors' Bills: The Doctors You Choose Determine How Much You Will Owe50
Private Contracts51
The "Approved Amount"52
Mistakes Are Made58
How to Find Doctors Who Accept Assignment60
Recap61
Chapter 8The "I Didn't Know" Rule62
How It Works63
Can You Get a Refund?65
Advance Beneficiary Notice67
Chapter 9Services Not Covered70
The Importance of This List72
What Is and What Is Not "Routine"73
Chapter 10Not for Diabetics Only75
Finding the Right Pharmacy or Supplier77
Some People Do Their Jobs Better Than Others80
For Diabetics Only82
Chapter 11Diagnostic Tests84
What Is a "Diagnostic Test"?84
What Kinds of Diagnostic Tests Are Covered?85
What Other Diagnostic Services Are Covered?85
Diagnostic Tests in Doctors' Offices and Laboratories86
Prohibition on Referrals86
Paying Diagnostic Testing Bills87
Chapter 12Durable Medical Equipment and Supplies88
What Durable Medical Equipment and Supplies Are Covered?88
When to Rent and When to Buy90
Participating Suppliers92
Chapter 13Ambulance Bills96
The Rules96
Medicare Denial of Ambulance Bills98
The New Changes to the Rules101
Chapter 14Outpatient Hospital Bills105
Services Included105
The "New" Outpatient Prospective Payment System106
The Budget Reconciliation Act of 1997107
Chapter 15The Medicare Part B Deductible108
How Do You Know When You Have Met the Deductible?109
Chapter 16Paying Part B Bills112
What to Do When Medicare Refuses to Pay a Bill112
When to Pay Part B Bills117
The "Rule of Anastasia" or, "Don't Pay Bills You Don't Have to Pay"121
Chapter 17Medicare Part C124
Background124
Who Is Eligible?129
Traditional Medicare versus Medicare + Choice (M+C)129
What Happens If "Harry" joins an HMO130
What Happens When "Harry" Joins a PSO131
What Happens When "Harry" Joins a PFFS131
The Pros and Cons of Joining a Medicare + Choice Plan132
Shopping for a Medicare + Choice Plan133
You've Finished Shopping; It's Time to Make a Decision137
The Least You Need to Know When You Join a Medicare + Choice Plan140
Chapter 18Appeals143
Appealing a Decision in a Medicare + Choice Plan143
Appealing a Decision Under Traditional Medicare145
Chapter 19Medigap Insurace149
It's as Easy as A,B,C150
The Ten Standard Medigap Policies152
Medicare Select155
You Have to Compare Prices158
Prescription Drug Coverage159
Preexisting Condition Clauses161
Shopping for a Medigap Policy162
Author's Note164
Chapter 20Supplementary Insurance167
When You Get Your Supplementary Insurance Through a Former Employer, Does It Do the Job?167
Buying a Supplementary Policy to Supplement a Supplementary Policy171
Advice for the Brave174
Who Pays First?174
Chapter 21Tricare for Life176
Who Is Eligible?176
How Much Does It Cost?177
Who Pays First?177
How the System--Medicare Plus Tricare--Works180
Chapter 22Odds and Ends183
Medicare versus Medicaid183
Blood Deductible184
Prescription Drug Coverage184
Did You Know?187
Final Words190
Organizations191
Hospice Organizations191
Long-Term Care Ombudsman195
Peer Review Organizations197
Durable Medical Equipment Regional Carriers201
Index205

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