Monday, June 5, 2017

Book Review: 'Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs' by Philip Moeller

Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs
By Philip Moeller

Review by David Wineberg

From those wonderful people who brought you Get What's Yours For Social Security, (see my review) comes the companion volume on Medicare. Social Security handles Medicare registration, which sadly does not simplify the process, and often complicates it as we start those programs at different ages. The bizarre healthcare system, which is the biggest cause of personal bankruptcy in the USA, is not simplified by the act of turning 65 or retiring. The games just change. Hence the screaming need for this book. New games. New hurdles. New penalties. We all need to know what we’re getting into, and precious few of us do. Philip Moeller has plumbed the depths for us, and he’s not happy about all the entanglements he found. Here are some samples:

-Medicare Part B has a 20% copay that is never satisfied. Patients with multiple appointments and procedures continually pay 20%. And 20% these days can bankrupt you by itself.
-Only 25% purchase Medigap insurance to cover the copays.
-COBRA does not delay the need to sign up for Medicare
- Health Savings Account contributions must cease six months prior to Medicare enrollment
-Although Social Security will send money anywhere in the world, Medicare is only available in the USA
-The penalty for late registration of Part D (drugs) is 1% per month you are late – added to all your monthly payments for life.
-On the other hand, if you take no drugs, you save nearly $1000 a year in the premiums and deductibles of Part D coverage.
-Unlike original Medicare, private Medicare Advantage plans usually end at the state line. They are the same sort of network HMO plans we despise, and that many can’t wait to abandon for Medicare. But they are subsidized by Medicare ($10,000 per person) and so have smaller premiums than Medicare.
-Even if they’ve dropped a drug from the formulary, plans are supposed to provide transitional fulfillment, and/or your doctor can apply for a continued supply.
-All Part D plans provide free Meds Therapy Management for those with multiple conditions and prescriptions. This can help prevent meds battling each other or causing unintended new conditions.
-If a provider tells you in advance you are not covered, you must ask them to file a claim with Medicare anyway. That puts you in the appeals process. If they don’t apply, you have nothing to appeal.
-Only 1% of appeals come from beneficiaries. 99% come from providers. There is a separate track for beneficiaries that takes them to the head of the line.

The endnotes in Get What’s Yours for Medicare are much more valuable than usual. They include deep links to the specific webpage where the form or information is available, stats that show how many people choose what plans, how much they spend and so on. They are a valuable tool themselves.

There isn’t a person in the world who has a complete understanding of Medicare. This book is critical to having an overview of the paths, the pitfalls, and the misconceptions about the program. And fortunately, it is easy and engaging reading.

Editor's note: This review was has been reposted with permission of David Wineberg. Like what you read? Subscribe to the SFRB's free daily email notice so you can be up-to-date on our latest articles. Scroll up this page to the sign-up field on your right. 

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