Today I would like to share with you a story from one of my reference books called “Get What’s Yours for Medicare” by Philip Moeller. It’s a great book that compliments the “Medicare & You” booklet that CMS (the Centers for Medicare and Medicaid Services) provides to Medicare recipients.
In chapter 1, Philip Moeller has titled it “No One Told Me” and he starts the chapter with stories for how things can go horribly wrong with Medicare, when you don’t understand how Medicare enrollment works and the important dates that apply.
Reading from the book, it goes:
Glen didn’t retire until he turned 70 in 2010. He and his wife, Margie, were covered until then, by his employer’s health plan. Glen read the annual Medicare & You guide put out by the Centers for Medicare and Medicaid Services (CMS).
His clear understanding from the guide was that he had been automatically enrolled in Medicare since he turned 65.
This was not true. Glen made a big Medicare mistake by not asking anyone to confirm his understanding. In fact, Glen had no Medicare coverage as of 2010. Neither did Margie. But they didn’t know this.
No one told me is a scary cautionary Medicare tale that could be the subtitle of this book. It is repeated in countless calls for help from people like Glen and Margie (not their real names) to Medicare consumer counselors and call-center staffers around the country. And it is voiced even by people who otherwise consider themselves smart and well-informed.
As it turns out, there can be little about Medicare that is automatic or clear or, especially in the midst of a medical emergency, logical or perhaps even fair. Despite widespread contrary beliefs, people are free never to get Medicare and can simply pay their own health bills without insurance. However, if you forgo Medicare and later change your mind, there can be steep late-enrollment penalties and many months may pass before insurance takes effect.
Even for people who want health insurance, Medicare usually isn’t even required at age 65 or, indeed, at any later age, so long as a person – or spouse – is still working and has group health insurance coverage from a current employer.
Social Security is supposed to send out Medicare cards to some people when they turn 65. Maybe it did send out a card to Glen. Maybe he thought this meant he was covered. But this doesn’t always happen, and especially when a person has not yet started taking Social Security retirement benefits.
There are three (3) really big deals about getting Medicare right:
1. Enroll at the right time. Medicare has a bewildering mix of enrollment periods. You need to use the right one.
2. Choose the right mix of Medicare coverage. There are only two main paths here. One is Original Medicare (Parts A and B), perhaps with a Medigap supplemental policy, plus a Part D prescription drug plan. The other is a Medicare Advantage plan, usually including a Part D plan.
3. Understand what these various parts of Medicare cover and how to use them.
For nearly four years, Glen and Margie had no health problems, serious enough to have caused them to file a claim with Medicare and learn about their earlier mistake. But then, in 2014, Margie got sick and was diagnosed with terminal cancer. They then began trying to file claims for what would be enormous medical expenses. That’s when they found out, that neither of them, had Medicare coverage. Glen called the nonprofit, Center for Medicare Advocacy, seeking help.
Glen had missed his original window to sign up for Medicare after he retired in 2010. Margie had assumed she was automatically covered by Medicare as well. The details aren’t clear, although it became clear in hindsight that they never really understood that there is no family coverage under Medicare, as is routinely the case with employer health insurance.