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Medicare 101: A Must-Read Guide to the Basics

Answers to frequently asked questions about the health insurance program for people 65+

Q: Can I see the doctors of my choice in Medicare?

A: Maybe. If you’re in a Medicare HMO, you must go to doctors in the plan’s provider network and you need a referral to see a specialist. In a PPO you can go out of network for a higher copay and don’t need specialist referrals. In traditional Medicare, you can see any doctor who accepts Medicare patients. The national shortage of primary care physicians is affecting Medicare as well as other insurance programs, and Medicare’s payment system has driven some doctors out of the program. But more than 90 percent of doctors still accept new Medicare patients, according to a recent government report. You’re free to see doctors who don’t accept Medicare, but only at your own expense.

Q: Do I have to sign up for Medicare again every year?

A: No, your coverage just rolls over from year to year unless you choose to change it. But you do have the opportunity to select a different kind of coverage during Medicare open enrollment, which runs from Oct. 15 to Dec. 7 each year. In this period, you can switch from traditional Medicare to a Medicare Advantage (MA) health plan and vice versa, or from one MA plan to another, or from one Part D drug plan to another. In some circum­stances, you can make these changes at other times of the year.

Q: Will Medicare coverage be cut off when I grow old?

A: No! Medicare coverage is based on medical necessity, not age. So if you need a hip replacement when you’re in your 90s and can physically tolerate the procedure, Medicare will pick up most of the cost in the usual way. The idea of Medicare rationing care and denying coverage for people over a certain age has been spread through mass emails designed to discredit the 2010 Affordable Care Act (commonly called Obamacare). In fact, the act doesn’t allow rationing, and no Medicare regulation limits care for people based on their age.

Q: Will Obamacare reduce my benefits?

A: No. The Affordable Care Act guarantees all current Medicare benefits and provides more. It makes many preventive services, such as mammograms, free of charge and slashes the cost of prescription drugs by gradually closing the Part D “doughnut hole.” People with Medicare are not eligible for Obamacare.

Patricia Barry writes the AARP Ask Ms. Medicare column and is the author of  Medicare for Dummies.

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