MEDICARE SURVIVAL GUIDE

Diane J. Omdahl, RN, MS is a true pioneer in the field of Medicare benefits. She is a registered nurse who launched her first company Beacon Health Corporation—a provider of Medicare-related education, training and tools for home health agencies, long-term care facilities and their employees—in the basement of her home and grew it into a multi-million-dollar company. Today, as the architect of i65—a software system providing step-by-step Medicare enrollment guidance—and President and co-founder of 65incorporated.com and i65.com, Omdahl uses her extensive experience to provide seniors, their families, and their professional advisors with unbiased, expert step-by-step Medicare enrollment guidance through fee-for-service consultations and online software. i65 gives people 65 and older, whether working or retired, the clear, correct, complete and credible information they need to make important Medicare decisions, and provides one-on-one consultations, unbiased online resources, and unique software for today’s Baby Boomers and seniors. An experienced and highly-rated speaker, Omdahl has delivered more than 400 Medicare-related audio conferences, 200 educational sessions, and 100 in-depth two-day seminars, along with producing instructional videos and educational resources for home health aides, registered nurses, therapists and consumers alike; including presentations at Bob Veres' Insider Forum and NAPFA and LPL conferences, along with webinars for Certified Senior Advisors, Women's Financial Empowerment Network, and Resilient Advisor. And she has also worked with some of the nation’s foremost corporations, like PBS and Macmillan Publishing, to provide their human resources staff, employees and retirees with expert, unbiased Medicare consultation and speaking services. She also served as a technical expert for the Centers for Medicare and Medicaid Services (CMS), the organization that runs the Medicare program. Omdahl is a retirement columnist for Forbes.com and has been featured in publications such as The Washington Post, The Wall Street Journal Market Watch, CBS MoneyWatch, Kiplinger, The Huffington Post, CNBC, American Journal of Nursing, Kitces, and more. Omdahl is the author of Using the Plan Finder: A Guide to Choosing a Medicare Advantage Plan, Beacon Guide to Medicare Service Delivery, Headstart to Quality Improvement in Homecare and Home Health Aide A to Z Pocket Reference. The author lives & works in the Milwaukee metro area. 65incorporated.com

TABLE OF CONTENTS to Medicare For You: A Smart Person's Guide by Diane J. Omdahl, RN, MS
GET MEDICARE RIGHT IN 7 EASY STEPS


INTRODUCTION 


STEP ONE: PREPARE FOR MEDICARE


Learn the terms.




Medicare Part A, B, D.
Medicare supplement plan.
Medicare Advantage plan. 
Guaranteed issue right. 



Buy a bigger mailbox. Get another recycling bin. Put new batteries in your remote control.






Facts about TV ads. 
Resist calling the phone number on the screen.



Establish or update your healthcare power of attorney.


Confirm your eligibility for Medicare.






Eligible to enroll in Medicare.
Eligible for premium-free Part A. 



Create a my Social Security account.


Know when to take action.


STEP TWO: DETERMINE YOUR TIMING


Three enrollment periods that are for getting into Medicare.


Initial Enrollment Period - everyone must pay attention.






Myth: must enroll at age 65. 
Guidance for specific situations
Receiving Social Security benefits before age 65.
Giving up coverage or no coverage.
Employer group health plan.
20 or more employees.
Fewer than 20 employees.
Keeping coverage after age 65.
HSA
Creditable drug coverage. 
Other types of coverage (COBRA, individual, retiree, VA).
Enrollment instructions. 



Part B Special Enrollment Period -for those who could delay enrollment. 






Who qualifies. 
Enrollment instructions. 



General Enrollment Period - oops, you’re too late. 






Enrollment instructions.
Late enrollment penalty.

STEP THREE: GET TO KNOW THE PARTS OF MEDICARE


Confusion: Medicare has four parts.


Medicare has three parts and they combine to make two paths. 


First the three parts.






Medicare Part A.
Medicare Part B.
Medicare Part D.



Then the paths (introduction).






Original Medicare.
Medicare Advantage.



STEP FOUR: PICK YOUR BEST MEDICARE PATH (HOW THEY WORK) 


Original Medicare






Medicare supplement (Medigap policy) and Part D drug plan.
Physicians, rules.



Medicare Advantage






Types of plans.
Networks.
Coverage rules
Out-of-pocket maximum.
Medicare giveback.
Extra benefits.



Changing paths down the road.






Guaranteed issue right.
46 states and NY, CT, MA, ME.
Medigap OEP.
Medicare Advantage Trial Period. 
When to change paths.
Open Enrollment Period.
Medicare Advantage Open Enrollment Period. 
Other opportunities.
Moving out of plan’s service area. 



STEP FIVE: LIVING WITH MEDICARE


Part D drug coverage.






Networks, preferred and standard pharmacies.
Tiers of drugs.
Formulary.
Payment stages.
Drug plan deductible.
Donut hole.
$35 insulin. 



Medicare costs.






Part B premium.
Medicare supplement, drug plan, Advantage plan.
Premiums. 
EOB.
Medicare summary notice. 



IRMAA.






Life-changing event.
One-time income. 



Preventive services.






Welcome to Medicare visit.
Annual wellness visit.
Vaccines.
Part B - flu, pneumonia, COVID.
Part D - shingles.



Moving.


POA not enough






Medicare representative.
Plan representative.



Medicare scams.


STEP SIX: KNOW WHEN YOU NEED MORE HELP


SSDI.


Not eligible for premium-free Part A.


Domestic partner.


FEHB.


Coverage after employment ends. 






COBRA.
Retiree plan.
VA, TFL.



Expatriate.


HSA.


Appeals.


STEP SEVEN: PAY ATTENTION TO COVERAGE EVERY YEAR


Open Enrollment periods.


Notice of changes.


Update Social Security information


INDEX


REFERENCES