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Maximizing Your
Medicare By Stacey L. Bradford, SmartMoney.com August 2007 Love it or hate it, if you're over 65 you've got Medicare. Around since the 1960s, this government program no longer resembles your mother's health insurance. That's because Medicare rules change every year. Staying on top of these changes can help you get the best medical care for your dollar. Here are four ways to optimize your health-care savings under the latest Medicare rules. 1. Know Your Coverage and its Limits If you're new to Medicare, the first
thing you should figure out is how the payment system works. If you stick
with the traditional Medicare Plan (Medicare Part B) for outpatient
services, the program covers 80 percent of your medical bills. You're
responsible for the remaining 20 percent. But if you see a physician who
doesn't take "assignment" (the reimbursement rate for Medicare),
he could pad your bill by an additional 15 percent and you'll have to pay
the difference out of pocket, warns Deane Beebe, public affairs director
for A more costly mistake, she says, is to see a physician that has opted out of Medicare entirely. To avoid any nasty surprises, always ask a medical provider if he participates with Medicare and if he takes assignment before you make an appointment. 2. Take Advantage of Preventative Benefits Medicare covers all sorts of preventive services ranging from flu shots, which are free, to cancer screenings that are reimbursed at 80 percent. Taking advantage of these benefits will not only help keep you healthy but they could also save you money -- diseases that are caught early tend to cost less to treat than more advanced ailments. "While these benefits are quite generous, they are not used to the extent that they should be," says Strollo. There's an added perk for new Medicare members. Within the first six months of enrollment, seniors get a one-time physical exam called "Welcome to Medicare." During this office visit, a doctor will review your overall health, offer advice and recommend any appropriate preventive screenings. Just make sure you don't wait to make your appointment. If you miss your window of opportunity, Medicare won't extend it for you. 3. Keep Your Retiree Benefits Since traditional Medicare doesn't
cover all of your health-related out-of-pocket expenses, it's important to
hang on to your retiree benefits. These benefits will act as a secondary
insurance plan and reimburse you for anything Medicare doesn't pick up,
says You do have other options to help cover your out-of-pocket expenses. The most popular alternative is a Medicare Advantage plan, which you could swap for your Medicare Part B plan. Medicare Advantage can be cheaper than paying for retiree benefits on top of Part B, but it also tends to be less generous in its coverage. Most of the independent Medicare Advantage policies look and feel like a managed-care plan that limits the doctors you can see and sometimes requires a referral before you can see a specialist. In addition, most seniors will still have to pay some out-of-pocket expenses. 4. Look For Additional Help Many seniors falsely assume that if they aren't eligible for Medicaid (a program for those with low incomes), then they won't qualify for any financial help, says Cheryl Matheis, an AARP spokeswoman. The reality is that the government offers four often-ignored Medicare Savings Programs that help seniors pay for everything from premiums to co-pays. "You don't have to be someone with no income to qualify," Matheis says. If you're eligible for one of these programs, you automatically receive help paying the cost of Medicare prescription drug coverage. The most generous program is called
the Qualified Medicare Beneficiary (QMB), which helps pay for both the
hospital (Part A) and outpatient (Part B) premiums, as well as your
out-of-pocket costs. To qualify, seniors can have annual incomes of up to
$10,452 ($13,932 for couples) and liquid assets under $4,000 ($6,000 for a
couple). Medicare beneficiaries with incomes up to $14,028 ($18,732 for
couples) can get help paying the Part B premium through the Qualifying
Individual (QI) savings program. More than 20 states have modified the
government's asset restrictions for QI, says More Information on US Health Issues
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