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.
Glen and Margie needed to file individually for Medicare. When they realized their error in 2014, they had missed one of the many enrollment periods available during the year and were told they had to wait until the beginning of 2015 to apply for Medicare. Under its rules, their coverage would not become effective until July 2015.
Glen and Margie had to face her cancer with no insurance whatsoever. Instead of being able to focus on Margie’s care and spending as much quality time with her as possible, Glen’s life instead included the prospect of crushing medical bills and the need to worry about how he would pay for his wife’s care.
Medical expenses are, sadly, a leading cause of personal bankruptcy.
After the center said it had no immediate solution to their problem, Glen broke off contact. More than a year later, the center reached him again. He is a defeated man, a staffer recalled. Things had turned out terribly. He did, indeed, lose his wife.
And he still didn’t know if he had Medicare.”
This story, and other examples in the book by Philip Moeller, “Get What’s Yours for Medicare” reveal a basic fact: Medicare can be a challenging system to navigate.
That’s why it’s important to seek help as you approach age 65 if you are considering enrolling into Medicare. “Get What’s Yours for Medicare” is an excellent reference book, for those of you considering Medicare or already enrolled in Medicare.
The important thing is to be informed so you can make the best decisions possible.
Feel free to contact me at 404-335-8798 if I can answer any questions for you.