SOME BASIC THINGS YOU SHOULD KNOW

SOME BASIC THINGS YOU SHOULD KNOW


If you are like most older Americans covered by Medicare,
there are aspects of the federal health insurance program that
you find complex and confusing. You may be uncertain about what
Medicare covers and doesn't cover and how much it pays toward
your medical expenses. And, like many other beneficiaries, you
want to know what, if any, additional health insurance you
should buy.

This booklet will give you a better understanding of your
Medicare benefits, identify the gaps in your Medicare coverage,
and provide tips on shopping for private health insurance to
fill those gaps. As a Medicare beneficiary, you probably are
already aware that Medicare does not cover all of your
potential health care costs. For example, you are responsible
for Medicare's deductibles and coinsurance and for charges for
services not covered by Medicare.

Few people can afford to pay all of those expenses out of
their own funds, so many rely on supplemental insurance to
cover some of the costs. As you seek to limit your
out-of-pocket costs for health care services, you will find
that there are three basic ways of doing so:

1. Through the purchase of Medicare supplement insurance,
which is also called "Medigap" or "MedSup" insurance;

2. By enrolling in a managed care plan, such as a health
maintenance organization (HMO) that has a contract to
serve Medicare beneficiaries; and,

3. By continuing coverage under an employer-provided health
insurance policy, if you are eligible for such protection.

In addition, for beneficiaries who qualify, some costs may
be covered by state Medicaid programs (see page 17).

Each of these ways will be discussed in subsequent
sections. Special attention will be devoted to employer plans
and Medigap insurance, which most Medicare beneficiaries
purchase.


Insurance Counseling


Although the information in this booklet will help you to
be a better informed and more careful purchaser, you may wish
to obtain additional information before buying health
insurance. Information about insurance to supplement Medicare
is available from various senior citizen advocacy organizations
and governmental agencies.

You first may want to turn to your state government for
help, as all states now offer insurance counseling in
one-on-one confidential sessions with trained counselors. In
these sessions, you will be able to clarify insurance issues
that you find confusing and receive assistance in evaluating
your insurance needs. These services are provided at no charge
to you.

The telephone number for your state insurance counseling
office is listed in the directory of state insurance
departments and agencies on aging beginning on page 27.