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American Medicine

Over the age of 65, most people are enrolled in Medicare. However the economy and deterioration of the value of retirement accounts has forced many senior citizens to reconsider the expense of Medicare. Often seniors become confused about their best insurance decisions. To compound the dilemmas of senior health, reduced Medicare payments have convinced many doctors to stop accepting new Medicare patients, suspend treating Medicare patients altogether, or even retire!

What should a senior person do to continue to get good health care? Here are my tips:

• If you can afford it financially, participate in Medicare, but also buy a supplemental plan, known as “medigap” insurance (insurance to cover the 20% co-pay on Medicare authorized tests and treatments) and a part D plan (to cover medications)
• Choose a doctor who participates in the Medicare program and insist on consultants and testing facilities who participate in Medicare
• Never let your insurance lapse
• If you cannot afford a supplemental plan or cannot afford the cash co-pays to cover the 20% Medicare does not pay for, consider a Medicare Advantage program (an HMO) even though it might reduce your choices of doctors or hospitals. Since it covers the co-pays, and some drugs, it maintains your access to good health care
• If you cannot afford Medicare, see a social worker or a state health services (seek out the Department of Health for your state/city) representative to see if you qualify for Medicaid or other low-income resources
• Never ever let a symptom go without medical evaluation or treatment
• If you have insurance coverage, but your doctor stops accepting Medicare, find another physician as soon as possible
• If you have all your health team and insurance in place, be sure to ask your doctor about all the prevention and screening tests you should have based on your current health conditions, family history of illness, and lifestyle habits. An ounce of prevention is now covered by your health plan, thanks to the Affordable Care Act.

For more information on insurance see Chapter 25 “Finding Health Insurance and a Broker”, and for guidance on choosing a doctor see Chapter 1 “Selecting a Primary Care Physician” in Surviving American Medicine.