THE MEDICARE ANSWER BOOK

The snarl of Medicare--precisely and dextrously untangled. Medicare, writes Harrington, presents two basic problems: its ""coverage"" has many gaps and most people don't understand it. So she starts from the top: Medicare is health insurance bought from the federal government by people who are 65 or older (with some provisos), or under 65 but disabled by certain diseases. Then she goes on to exactly what is covered. Not only are there large, identifiable gaps (e.g., nursing-home coverage is limited to the relatively few Skilled Nursing Facilities); but constant changes in both the guidelines and the reimbursements mean that it is ""actually impossible,"" sometimes, to know what Medicare will cover. Harrington indicates the difficulties most likely to arise and assesses supplementary ""medigap"" insurance (sometimes useful, but also exploitable by con men); as an alternative, she strongly favors Health Maintenance Organizations (whose membership fees are payable partly by Medicare). Other problems that receive special attention: how to fill out claim forms; how to disagree when claims are refused; when a second opinion may be sought. A final section features the most commonly asked questions. Whereas Kal Waller's How to Recover Your Medical Expenses (1981) approached the Medicare snarl in a practical, workbook fashion (to be used in sorting out individual situations, including figuring tax deductions), Harrington's exemplary guide provides a much more detailed explanation of how Medicare itself is currently organized--and highlights the areas in which problems usually arise.