Why Does Medicare Have To Be So Confusing?

Medicare can seem confusing because they have tried to develop a system to accomodate a variety of lifestyles and financial situations across the country. In addition, they work to give Medicare beneficiaries as many options as possible when they move or if their health or financial conditions change.

This is a high level overview of the different Medicare parts and systems. My goal is to give a general overview so you can start to get your arms around Medicare and develop questions. Everyone has unique circumstances and not all parts may apply. Other confusing aspects are all the eligibility, enrollment, and guarantee issue periods. While those are very important parts of the puzzle, they can distract from learning the basics. Medicare is very good about notifying you on your eligibility.

1. Learn as much about the basic parts of Medicare as possible. It is best to understand the various parts, and then focus on rules, regulations, eligibility, etc.

Part A: Hospital. This covers you when you are admitted to a hospital

Part B: Medical. This portion addresses your regular Doctor office visits.

Part D: Prescription Drug Plans.  Helps with the cost of medications.

Part C: Medicare Advantage Plans. These plans, usually administered by private insurance companies, provide Part A, B and often times D to the member.

Medicare Supplements: These are additional insurance plans, offered by private companies, which pay for deductibles, copays and coinsurance not covered by Original Medicare.

Flow chart of Medicare_options_flowchart

2. Find out what is available in your area on or contacting an agent. There is no reason to dwell on the advantages or disadvantages of a particular plan if it is not offered in your area. Of course, Original Medicare, Parts A and B, is always available. The Part D Plan is also offered by State.

3. Review your health history and financial situation. Often times your particular situation or preference will help guide you to making the best selection.

a. Do you have particular doctors or hospital you want to keep?

b. Do you need to see your doctor on a regular basis?

c. What type of prescriptions do you take?

d. Do you like to travel?

e. Will you need assistance paying for premiums and out of pocket expenses?

d. Are you still working and covered by your employer or spouse’s health plan?

These are just a few questions to consider.

4. Shop, Compare, Talk. Get as much information on all of the plans offered in your area and compare them to one another. Talk to your family, friends and neighbors to find out what has worked for them and what they like. If possible, try and create a spreadsheet of the different plans, costs and benefits (downloadable file on my Home page). Never be talked into signing up for a particular plan. You are in the driver seat and you should feel comfortable with your selection.

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  • Theresa Powell

    Now this is sincerely the best breakdown of how Medicare works, I’ve ever read. It will take a day to digest, but at least I feel like I’ve got a handle on it. Really thought Part D and C were merged. I often can’t get the script the doctor wants me to have, and have experienced being covered for scripts one year, then the next year something I take daily isn’t covered anymore.
    Partially because when ur dealing with serious illnesses, you’re already overwhelmed with decisions. Then you have to pick different companies who all claim to offer the best care? Everybody needs to read this an all the links if they have Medicare! Thanks for breaking it down!!

    • Kevin Knauss

      Parts D and C can be merged in some Medicare Advantage. The nomenclature will be MA-PD. Any time you see that, it is a combination of a Medicare Advantage and Part D. While most Medicare Advantage have the Part D built in, not all of them do. When you are a variety of medications, it is of paramount importance to research the Part D pharmacy program of the plan. While all Part D plans must include a basic formulary list of prescriptions, there can be differences.

      For instance, one plan may have a particular brand name in tier 2 while another plan may have it tier 3 and another plan may not include it at all (no coverage). The website has a good plan finder that included Drugs. You can save it from year to year so you don’t have to input the meds each time.