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2025

Format:	Book
Author:	Barry, Patricia (Medicare expert), author.
Title:	Medicare / by Patricia Barry.
Edition:	5th edition.
Publisher, Date:	Hoboken, NJ : John Wiley & Sons, [2025] ©2025
Description:	xv, 412 pages : illustrations ; 24 cm. illustration
Summary:	Medicare decisions made easy The newly updated Medicare For Dummies offers clear, step-by-step instructions on how to navigate the complex Medicare system. It takes you from the enrollment process to making use of expanded coverage to customizing a plan for your needs. Written by Medicare expert Patricia Barry, this book is your trusted and proven guide to reducing your out-of-pocket expenses and picking the perfect policy for yourself and your family. Inside... Learn the basics of Medicare Determine the best policy for you Reference the latest prices and coverage options Navigate the Medicare system Use Medicare for mental healthcare Get coverage for your family members Avoid unpleasant coverage surprises.
Series:	For dummies --For dummies.
Subjects:	Medicare. Health insurance -- United States. Medicare -- Popular works.
Other Author:	AARP (Organization)
Notes:	"Get tips on navigating the Medicare maze. Determine the best time to enroll and how. Save money by avoiding costly mistakes" -- Cover. "AARP"--Cover. Includes index.
Contents:	The nuts and bolts of Medicare : what it is and how it works -- Spelling out what Medicare covers (a lot, but not everything) -- Understanding what you pay toward your costs in Medicare -- Reducing your out-of-pocket expenses in Medicare Qualifying for Medicare -- Enrolling in Medicare at the right time for you -- Discovering how to sign up for Medicare -- Understanding how Medicare fits in with other health insurance Making sense of Medicare's many options -- Choosing wisely if you go with traditional Medicare -- Making smart choices if you opt for Medicare Advantage -- Getting help in making Medicare choices Starting out as a new Medicare beneficiary -- Getting the inside scoop on using certain Medicare benefits -- Changing your Medicare and Medigap coverage -- Knowing your rights Top ten Medicare mistakes -- Ten ways to stay healthier beyond age 65 Appendix A: Sources of help and information -- Appendix B: Glossary.
LCCN:	2024942275
ISBN:	1394267967 (pbk) 9781394267965 (pbk) 9781394267965 9781394267965
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Summary

Cracking the Medicare code

Medicare For Dummies is your ultimate cheat sheet to demystifying Medicare. This newly updated guide covers the latest changes in benefits, including expanded coverage for mental health and chronic pain. In simple language and clear step-by-step instructions, this bestseller walks you through the enrollment process and helps you avoid costly mistakes along the way. You'll learn how to reduce your out-of-pocket expenses, and you'll get trusted guidance on finding the perfect policy for you and your family. Find answers to all your Medicare questions--even those you wouldn't think to ask--so you can develop a solid game plan to get the most out of Medicare.

Learn the basics of Medicare and determine the best plan option for you Reference the latest prices, coverages, and other must-know information Get tips for minimizing your out-of-pocket expenses, whatever your health situation Find clear and thorough guidance for navigating Medicare at any age

If you're currently enrolled in Medicare and want to maximize their benefits, or if you#re thinking about enrolling soon, Medicare For Dummies will help you better understand the often confusing process. This book is full of examples, ideas, and useful takeaways that empower you to take control of your healthcare--and your health.

Table of Contents

	Introduction	1
	About This Book	2
	Foolish Assumptions	3
	Icons Used in This Book	4
	Beyond the Book	4
	Where to Go from Here	5
Part 1	Getting Started with Medicare	7
Chapter 1	The Nuts and Bolts of Medicare: What It Is and How it Works	9
	Addressing Some Upfront Questions	10
	Coming to Terms with the ABCs (and D) of Medicare	12
	Recognizing That You Have Choices and Must Make Timely Decisions	16
Chapter 2	Spelling Out What Medicare Covers (A Lot, but Not Everything)	19
	Understanding What Part A and Part B Cover	20
	Necessary medical care	20
	Preventive care	21
	Specialized care in certain circumstances	24
	Medical supplies and equipment	29
	Knowing What Part D Covers	30
	Making sense of drug coverage that can vary throughout the year	30
	Finding out about formularies	32
	Determining when drugs are covered by Part A, Part B, or Part D	34
	The Gaps: Discovering What Medicare Doesn't Cover	35
	Routine hearing, vision, dental, and foot care	35
	Home safety items	36
	Nursing home care	37
	Medical services abroad	38
	Services that may be nice but aren't necessary	39
	Distinguishing When Coverage Comes with Limits	40
	Limits on hospital stays	40
	Limits on skilled nursing facility stays	41
	Limits on mental health benefits	41
	Limits on therapy services	42
Chapter 3	Understanding What You Pay Toward Your Costs in Medicare	45
	Boning Up on Premiums, Deductibles, and Co-payments	46
	Part A costs	47
	Part B costs	49
	Part D costs	50
	Medicare Advantage costs	51
	Paying Higher-Income Premiums	52
	Understanding who's liable for the surcharges	53
	Figuring out what the surcharges cost you	56
	Getting the surcharges waived	57
	Paying Different Premiums than Other People in Certain Years	59
	Paying Medicare Taxes While Receiving Medicare Benefits	60
Chapter 4	Reducing Your Out-of-Pocket Expenses in Medicare	63
	Purchasing Medigap Insurance	64
	Examining Medigap policies	65
	Choosing and buying a Medigap policy	69
	Qualifying for Help from Your State	69
	Medicaid	70
	Medicaid medical spend-down programs	72
	Medicare Savings Programs	72
	PACE plans	73
	State Pharmacy Assistance Programs	74
	Examining Whether Extra Help Can Lower Your Drug Costs	75
	Qualifying for Extra Help	76
	Applying for Extra Help	77
	Choosing a drug plan with Extra Help	84
	Considering Other Ways to Cut Costs	87
	Taking income tax deductions for Medicare costs	87
	Lowering drug costs without Extra Help	88
Part 2	The Hows and Whens of Medicare	93
Chapter 5	Qualifying for Medicare	95
	Hitting the Milestone of Age 65	96
	Debunking some qualification myths	96
	Meeting the requirements for Parts A, B, and D	97
	Qualifying for Part A on your own work record	98
	Being eligible for Part A on someone else's work record	100
	Qualifying for Medicare under Age 65 on the Basis of Disability	102
	Receiving disability payments	102
	Suffering from permanent kidney failure (ESRD)	104
	Living with Lou Gehrig's disease (ALS)	105
	Falling through the Cracks: Healthcare Options if You Can't Get Medicare Yet	105
	Nice work if you can get it: Landing a job with benefits	106
	Paying for COBRA temporary insurance	106
	Purchasing individual insurance through the online Marketplace	107
	Buying health insurance outside of the Obamacare Marketplace	108
	Getting healthcare without insurance	109
Chapter 6	Enrolling in Medicare at the Right Time for You	111
	At a Glance: Surveying Situations That Affect Enrollment Timing	112
	Understanding Your Initial Enrollment Period	114
	Using your IEP at age 65	114
	Taking advantage of your IEP when you have disabilities	115
	Delaying Part B if You'll Qualify for a Special Enrollment Period Later	116
	Being able to delay Part B without penalty	117
	Knowing what to do about Part A if you delay Part B	119
	Heeding a special warning if you have a health savings account at work	120
	Using the special enrollment period	122
	Enrolling in Other Specific Situations	123
	You're a legal permanent resident	123
	You live outside the United States	124
	You're in a domestic partnership	127
	You're incarcerated	128
	Deciding Whether and When to Sign Up for Part D Drug Coverage	128
	Assessing drug coverage you have from elsewhere	129
	Debating whether you need Part D if you don't take medications	131
	Figuring the best time to enroll in Part D	131
	Understanding the Consequences of Not Signing Up at the Right Time	133
	Missing your deadline for Part B	134
	Passing your deadline for Part A	137
	Neglecting your deadline for Part D	138
	Figuring out whether you can get a late penalty revoked	141
Chapter 7	Discovering How to Sign Up for Medicare	145
	Being Automatically Enrolled in Medicare Parts A and B	146
	Sign Me Up! Applying for Medicare Parts A and B	147
	Signing up from inside the United States	148
	Enrolling while you're living abroad	151
	Opting Out of or Disenrolling from Part A or Part B	153
	Declining Part A	154
	Opting out of Part B	154
	Disenrolling from Part B	157
	Knowing When Your Coverage Begins	158
	When you sign up during the first three months of your IEP	159
	When you sign up during IEP months four through seven	160
	When you are awarded Medicare coverage retroactively	160
	Transitioning from Obamacare to Medicare	161
	Figuring out whether you need to make the switch	161
	Knowing how and when to switch from Marketplace to Medicare	164
Chapter 8	Understanding How Medicare Fits In with Other Health Insurance	167
	Understanding Medicare's Coordination of Benefits System	168
	Helping Medicare help you: Filling out your initial enrollment questionnaire	169
	Keeping Medicare informed if your coverage changes	170
	Seeing How Medicare Works with an Employer's Health Insurance Plan	170
	Working with insurance from a current employer	171
	Having insurance from a former employer	174
	Figuring Out How Other Federal Health Benefits Fit In with Medicare	178
	The Federal Employees Health Benefits Program	178
	TRICARE and TRICARE For Life	180
	The Veterans Affairs health system	184
	The Indian Health Service	185
	The Black Lung Program	186
	Mixing Medicare with Workers' Comp or No-Fault or Liability Insurance	187
	When you first make a claim	188
	If the claim isn't settled promptly	188
	When the claim has been settled	189
Part 3	Making Smart Choices Among Medicare's Many Options	191
Chapter 9	Making Sense of Medicare's Many Options	193
	Seeing the Big Picture: Your Starting Point to Navigating the Medicare Maze	194
	Understanding the consequences of your choice of system	194
	Weighing the two systems	197
	Recognizing when you may not have a choice	200
	Being on your guard against "default enrollment"	201
	Digging into the Details of Original Medicare versus Medicare Advantage	202
	Opting for original Medicare	204
	Looking at Medicare Advantage plans	204
	Checking out three other types of Medicare health plans	208
	Discovering How Medigap Policies Differ from Medicare Advantage Plans	209
Chapter 10	Choosing Wisely If You Go with Original Medicare	211
	Understanding the Need to Compare Part D Plans Carefully	212
	Knowing what not to do	212
	Defining "the best plan"	213
	Recognizing that comparing plans is worth the effort	214
	Seeing how comparing plans can save big bucks	215
	Getting organized with two crucial lists	217
	Picking the Part D Plan That's Best for You	219
	Assessing the Plan Finder's reliability	219
	Using the Medicare Plan Finder to discover options available to you	221
	Drilling down to important bits of info when comparing Part D plans	224
	Choosing the Medigap Supplemental Policy That's Best for You	228
	Choosing a Medigap policy	229
	Buying a Medigap policy at the right time	230
	Buying Medigap if you're under 65	233
	Suspending a Medigap policy	235
Chapter 11	Making Smart Choices If You Opt for Medicare Advantage	237
	Comparing Medicare Advantage Plans	238
	Comparing plans' benefits	239
	Adding prescription drug coverage	243
	Choosing the Medicare Advantage Plan That's Right for You	245
	Figuring out which providers accept the plans you're considering	246
	Enrolling in a Medicare Advantage plan	247
	Taking action if you change your mind	247
Chapter 12	Getting Help in Making Medicare Choices	249
	One on One: Getting Personal Help on Medicare Issues	250
	Asking family and friends	250
	Contacting State Health Insurance Assistance Programs	251
	Calling Medicare's help line	252
	Seeking advice from other sources	253
	Buyer Beware! Avoiding Scams and Hard-Sell Marketing	255
	Steering clear of outright scams	255
	Resisting hard-sell marketing tactics	258
Part 4	Navigating Medicare from the Inside	263
Chapter 13	Starting Out as a New Medicare Beneficiary	265
	Playing Your Cards Right	266
	Understanding when to use each card	266
	Replacing your cards	269
	Beyond the Cards: Checking Out the Extent and Limits of Your Coverage	269
	Managing Premiums	271
	Discovering different ways to pay Medicare premiums	271
	Knowing what can happen when you don't pay your premiums on time	274
	Keeping Track of Your Expenses	277
	Understanding Medicare Summary Notices	278
	Maintaining hard-copy records you can rely on	280
	Tracking information online	281
	Dealing with Doctors	282
	Finding doctors who accept Medicare patients	282
	Understanding what doctors can charge you	283
	Filling Prescriptions for the First Time with a Part D Plan	285
	When does my coverage begin?	285
	Which kind of pharmacy can I use?	286
	What happens if I go to an out-of-network pharmacy?	288
	How do i prove I have Part D coverage?	289
	How can I ensure I get my meds?	290
Chapter 14	Getting the Inside Scoop on Using Certain Medicare Benefits	293
	Taking a Closer Look at Part A	294
	Understanding hospital benefit periods	294
	Taking note of the three-day rule	296
	Defining observation status	297
	Being aware of the improvement standard	299
	Fighting premature hospital discharge	300
	Proceeding if the hospital makes a mistake	301
	Knowing your rights in a skilled nursing facility	301
	Zooming In on Part B	305
	Checking on whether Medicare will cover your treatment	305
	Receiving a notice saying that Medicare may not pay	306
	Determining whether you can find out a service's cost in advance	308
	Maximizing your chances for coverage	309
	Recognizing your right to second opinions	310
	Filing a claim directly to Medicare	311
	Delving into Part D	312
	Understanding how a plan may restrict your drug coverage	312
	Grappling with the tier system of co-pays	315
	Navigating the doughnut hole	317
	Using Part D to get the shingles vaccine	319
	Taking advantage of free Medication Therapy Management benefits	319
Chapter 15	Changing Your Medicare and Medigap Coverage	321
	Switching Coverage during Open Enrollment	322
	The open enrollment period	322
	The Medicare Advantage open enrollment period	323
	Taking Advantage of Special Enrollment Periods	324
	Recognizing when you can use SEPs to change plans	325
	Making sure your records and prescriptions are transferred	329
	Dropping a Plan (or Being Dropped)	331
	Leaving a plan on your own	331
	Getting the boot from your plan	332
	Deciding Whether to Stay or Switch to Another Plan for Next Year	333
	Reading your Annual Notice of Change to understand plan alterations	334
	Comparing plans (yes, all over again!)	336
	Looking at extra factors influencing your decision	336
	Changing to Another Medigap Policy	337
	Knowing the consequences of switching Medigap policies	339
	Exploring a change of Medigap coverage	340
	Exercising your right to a 30-day free look	340
Chapter 16	Knowing Your Rights	341
	Understanding Your Right to Accurate Information	341
	Knowing whom to call	342
	Seeking a second opinion	343
	Asking for an Investigation	344
	Requesting equitable relief	344
	Contacting an ombudsman	345
	Reaching out regarding quality of service	345
	Getting ahold of your plan	346
	Filing a grievance	346
	Taking Steps toward an Appeal	347
	Obtaining a formal denial	348
	Requesting a coverage determination	348
	Having a game plan in mind before you move ahead with an appeal	350
	Filing a Formal Appeal	351
	Walking through the five levels of appeal	351
	Getting help in making an appeal	355
Part 5	The Part of Tens	357
Chapter 17	Top Ten Medicare Mistakes	359
	Thinking You Must Reach Full Retirement Age before Signing Up	360
	Assuming You Don't Qualify If You Haven't Worked Long Enough	360
	Failing to Enroll in Part B When You Should	361
	Believing You Don't Need Part B If You Have Retiree or COBRA Coverage	361
	Not Signing Up for Part D Because You Don't Use Prescription Drugs	362
	Picking a Part D Drug Plan for the Wrong Reasons	362
	Misunderstanding Enrollment Periods	363
	Being Too Late to Buy Medigap with Full Protections	363
	Failing to Read Your Annual Notice of Change	364
	Not Realizing You May Qualify for Help to Lower Your Costs	364
Chapter 18	Ten Ways to Stay Healthier beyond Age 65	367
	Taking Action to Avoid Fails	367
	Exercising Regularly	369
	Quitting Smoking	369
	Eating Healthfully	370
	Cutting Out Soft Drinks and Extra Sugar	371
	Keeping an Eye on Prescription Drugs	371
	Continuing to Work or Stay Active	372
	Staying Connected and Engaged	372
	Keeping Your Brain in Shape	373
	Addressing Tough Choices before They're Necessary	373
Part 6	Appendixes	375
Appendix A	Sources of Help and Information	377
Appendix B	Glossary	389
	Index	395

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