How I Use My Medicare Coverage

I'm retired and after a long career at Prudential Financial, I'm fortunate to have great retirement health insurance coverage in addition to Medicare. It didn't just happen by accident, I planned carefully and made sure my wife and I had enough health insurance coverage, in addition to Medicare benefits.

Medicare is the government health insurance plan provided for people over 65. This is different from Medicaid, which is a similar program for low income people. Medicare also covers disabled people under age 65, but I'm talking about the standard retirement coverage offered. Like millions of other Americans, I had been paying taxes and premiums from my paycheck that go to Medicare benefits.

I have Medicare insurance and have used it for numerous things, from routine doctor visits to heart and cancer surgery. Although there is basic coverage, I have been shocked to see the huge gap that exists after the Medicare coverage ends. I have learned you need supplemental coverage to properly prepare for health emergencies and ensure you receive the best care.

Medicare is made up of four parts:

Part A covers hospital care, skilled nursing, hospice and home health care.

Part B covers doctor visits, medical professionals and home health services.

Part C is like an HMO or PPO, with a network of preferred providers whose services are paid at a higher share than non-network providers.

Part D covers prescription medication.

To get my Medicare coverage, I first chose whether I wanted the standard Medicare plan or the HMO-like Medicare Advantage plan. I chose the standard plan as I wanted complete flexibility to choose my doctors. Then I had to choose whether I wanted the prescription drug coverage, which I also wanted. The last part of the process was to choose to get a supplemental policy, to cover that gap after Medicare's limited coverage ends. Medicare has official approved plans, but we had coverage through my Prudential retirement benefits.

As a Prudential retiree, our Medicare supplement plan is administered by Aetna and it really offers me great coverage. First the medical bills go to Medicare for their payment, then they go to Aetna, who pays the balance. For a major heart surgery, which cost close to $500,000 according to the bills, we paid about $5000 out of our pocket.

I always review any procedures or major expenses before they are incurred with both providers to make sure things are covered. I also review the plan materials carefully and read the fine print so I know what is covered and what isn't. The U.S. government's official Medicare website is another great resource, with detailed information on benefits and coverage, along with helpful calculators and other tools.

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