• Coleen Merk

Navigating Medicare - Oh My!

I turned 65 this month...

And oh my goodness, the past six months have been loads of fun navigating the Medicare world!  (...said no one ever.)

I received notice that, as of January 1, 2019, my primary doctor was no longer accepting Medicare patients. Did I mention this is the same doctor to whom I have been faithfully seeing as a patient for the last twenty - yes twenty - years? I was shocked to find out it did not matter if I was an existing patient or not - - UNLESS - -  I signed up for their Medicare Advantage Plan.

Okay, so what is Medicare Advantage Plan? I checked it out to see if it was appropriate for me or not. I didn't love the fine print.



Yes, I certainly like my doctor, but I also appreciate the flexibility to change providers if I feel as though he is not serving me anymore.  The Advantage plan is a health plan by a private company that contracts with Medicare and provides all of Part A and Part B. It is almost exactly like an HMO plan! I felt extremely limited and did not like that I could only see a specialist after being recommended by my primary doctor. This particular plan also would not cover me if I went out of the state or country. So no access to medical help!

YIKES. I think I'll pass on the Advantage Plan.

As I was researching this uncharted Medicare territory, I found out I could apply for Medicare a few months before I turned 65. That was easy to sign up for, and I had my Medicare card in plenty of time before my 65th birthday. I also have coverage for Part A and Part B.

Okay, so then I realized the next step was I needed a new doctor.

I obtained a list of primary care doctors listed as accepting patients with Medicare. As I was making my calls, thought, I found out a lot of these doctors DO NOT ACCEPT Medicare patients, even though they are on this elusive list!  Or they are not accepting new patients. Oh great, you reach this point in your life, your current doctor will not accept Medicare unless you get their plan, and a lot of doctors will not accept me as a new patient! I could have been ready to give up, but I stayed the course.

With persistence and patience, and numerous calls and emails, I was successful in booking an appointment with a new doctor. I saw them before I became eligible for Medicare and got established. This week I went in as a MEDICARE patient to see my new doctor!

There is a whole new world out there called Medigap Plans. This is extra health insurance that you can purchase from a private company to cover insurance costs not covered by original Medicare, such as co-payments, deductibles, health care if you travel outside the United States. In other words, they fill in the gaps that the original Medicare does not cover. The Medigap plans get their information directly from Medicare and “accept assignment” from them. So, that explains why a lot of the doctors I called were not accepting Medicare patients or any new Medicare patients.

Maneuvering through Medigap Plans was a bit challenging. There are quite a few things to learn and after getting help from several different insurance agents, I ended up going rogue and out on my own. One of the insurance agents had their own method of educating potential clients and frankly, I was offended. They indicated they had this down and took about 3 different sessions so we would not be overwhelmed with the amount of information they thought I would be able to handle. PLEASE. I did get past the first grade and don’t assume I'm just like everybody else. Just because I am now 65 does not mean I need to be spoon-fed like a first grader.

Thank goodness for the internet and www.Medicare.gov was very informative and helpful and I was able to make a choice I am comfortable with and confident about. Dealing with insurance plans and medical coverage can be downright overwhelming, but there are so many resources out there if you aren't afraid to ask for help.

Be sure to tune back in and find out how I am navigating social security along with Medicare. Stay tuned for next month's post!

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