Critical Thinking, Govt Agencies, and Private Companies

• Social Security Administration (SSA)—You deal with the SSA to enroll in Medicare. Your current and past employment both figure in your decision of whether or not to enroll when you turn 65 and are first eligible. You should feel confident in your decision before you enroll. If you are still working, you should know the reasons to enroll and not enroll when you are turning 65. We can help. When you are fully enrolled in Medicare, you receive Medicare Part A and Part B. Together, these Parts constitute Original Medicare. With Original Medicare, you are qualified to enroll in either a Medicare Advantage Plan or a Medicare Supplement Plan, the primary two approaches to senior healthcare coverage.

• Medicare (CMS)—As your own agent, you may or not find yourself having to deal with the people at Medicare (technically, the Center for Medicare and Medicaid Services or CMS). More than 50% of people just work with insurance companies and never work with Medicare personnel directly. Still more all their doctors and hospitals to work with Medicare. However, there may be times when you need to call and work through something with their operators. 

• Critical Thinking—If you are your own agent, there is a good chance you will want to enroll in one plan or another at Medicare. gov. To do this, you should know that the 3 most important criteria are (1) the projected annual costs of plans to someone with your medications and health conditions, (2) the cost to you for the medications you take for each plan offered where you live, and (3) which provider networks your doctors participate in. Of course, you should also consider a few other things that you will think of on your own after all your experience with health insurance: (a) a plan's customer service, (b) the structure of its benefits, and (c) its federal star rating. The 2 criteria that should not be uppermost in the mind of a do-it-yourself agent are (1) brand name and (2) lowest premium. Using those 2 misleading criteria is a simplification that does not take into account all sorts of things that will affect your satisfaction with the plan throughout the year. Those 2 criteria should be conclusions you draw rather than primary factors in your decision. 

• Insurance Companies—Everyone should be covered by an insurance plan overseen by the federal government—unless they have taken a moral stance not to use medications and are confident that they will not change their minds. Except for this circumstance, everyone should expect to wind up talking with at least one insurance company because of claim denials, pre-authorization for procedures, misbillings, and so on. You will need to learn the vocabulary for dealing with them.

• Medicare Providers—Everyone will deal with a person or organization that offers and delivers diagnostic, therapeutic, or health-maintenance services. The category of Medicare providers includes doctors, labs, clinics, hospitals, and so on. These guys are under a lot of pressure, so billing and coordination seem more prone to errors than in the past. As your own agent, you will want to examine provider policies and services quite closely.