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Health Care & Insurance

Guide to Getting the Most Out of Medicare, 2015

You could pay more in premiums or miss out on benefits if you don't know the rules. We tell you everything you need to know.

Retirees count on Medicare to cover the bulk of their medical expenses, but the rules are complicated and it’s easy to make costly mistakes if you don’t know how the system works. Sign up too late and you could face a gap in coverage, or wind up paying a penalty on top of your regular premium for the rest of your life. Fail to understand what’s covered—and where to get help if coverage is denied—and you risk missing out on valuable benefits.

See Our Slide Show: 11 Common Medicare Mistakes

This comprehensive guide to Medicare will help you navigate the system, avoid problems and make sure you’re getting all the benefits you deserve. We also explain the best ways to fill Medicare’s considerable gaps.

When to Sign Up for Medicare

The federal government sends “welcome to Medicare” packets only to people who are already receiving Social Security benefits. If you’re not among them, you’re on your own in deciding how and when to sign up. And the stakes are high: Big coverage gaps and potential lifetime penalties could result from missing key deadlines. Read the full story here.

Fill in Gaps in Your Medicare Coverage

Medicare covers the bulk of your medical expenses, but you must pay deductibles and co-payments for hospital stays and doctors’ services; fees for doctors who charge more than Medicare pays; the cost of prescription drugs and other expenses, including dental; and care in a foreign country. Read the full story here.

Medicare Prescription Drug Coverage

With rare exceptions, Medicare doesn’t cover prescription drugs at all unless you’re in the hospital. There are two ways to fill the gap if you don’t have retiree health insurance. You can either get a Medicare Part D prescription-drug plan (paired with a medigap plan for your other out-of-pocket costs) or buy a Medicare Advantage plan that includes both medical and drug coverage. Either way, you need to follow a similar process when shopping. Read the full story here.

Health Savings Accounts and Medicare

A health savings account can be a great source of tax-free money for medical expenses and some premiums, even after you’re on Medicare. You can use HSA money for out-of-pocket costs, such as co-payments and deductibles for medical care and prescription drugs; vision and dental care; and a portion of qualified long-term-care premiums. Read the full story here.

Medicare Pitfalls to Avoid

Medicare has strict requirements for certain kinds of care, which can lead to claims problems. One of the biggies is getting coverage for skilled nursing or skilled rehab care. Medicare covers up to 100 days in a skilled nursing facility if you need skilled nursing care seven days a week or skilled rehabilitation services at least five days a week. Read the full story here.

How to Track Your Medicare Claims

Medicare makes the first step in the claims process easy: Providers usually submit the claims to Medicare, so you don’t have to do it yourself. But it can be complicated to keep track of the paperwork and to make sure you don’t pay more than you owe when you’re coordinating several types of coverage. Read the full story here.

How to Reduce Medicare High-Income Surcharges

For most people, the Medicare Part B premium is $104.90 per month in 2015. But your monthly bill could be between $146.90 and $335.70 per person if your adjusted gross income (plus tax-exempt interest) is higher than $85,000 if you’re single or $170,000 if you’re married filing jointly. Read the full story here.

How to Appeal a Denied Medicare Claim

If your claim is denied, first talk with the doctor (or hospital) and Medicare to see if you can identify the problem and get the claim resubmitted. “When Medicare rejects a bill, it’s often because it wasn’t billed properly,” says Murphy, of the Center for Medicare Advocacy. “Call the doctor’s office and ask why it was rejected.” The office may just need to coordinate Medicare with your medigap policy or fix a coding mistake. Read the full story here.

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