AGING WITH CARE | What you should know:
Medicare basics, open enrollment
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By Marla Beck, Columnist
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Everyone knows we
become eligible for Medicare when we turn 65. A few months before turning 65,
you’ll receive your Medicare card in the mail and have the option of
enrolling.
If you are collecting
Social Security, you will be automatically enrolled.
Still, the intricacies
of Medicare and choosing supplemental insurance can be daunting.
Original Medicare
Medicare has three
parts. For most people, Part A is provided at no cost; it covers
hospitalization.
Part B covers
outpatient treatment. If your individual income is below $85,000 ($170,000 for
a couple), the monthly fee for Part B is $104.93. Together, Parts A and B are
referred to as “Original Medicare.”
Since Original
Medicare does not provide prescription coverage, you should sign up for a
prescription-drug plan — this is Medicare Part D. If you forego prescription
coverage, there will be a monetary penalty for enrolling later.
With a qualified,
workplace medical insurance plan you can defer enrollment in Medicare.
So the question is, if
I have Medicare, why consider purchasing additional insurance? The reason: As a
standalone, Original Medicare coverage has glaring deficiencies.
Part A hospitalization
has a deductible fee of $1,184 per incident. There is a 60-day coverage limit;
then you’ll be charged $296 per day for the next 30 days. After 90 days, you’ll
be charged $592 per day.
Part B, which provides
outpatient coverage, has an annual deductible of $147; after that, doctor fees
are split 80/20.
Medicare has NO
out-of-pocket expense limit.
Medicare coverage of
dental, hearing, and vision is extremely limited.
Supplement and
Advantage plans
Here’s an overview of
auxiliary Medicare coverage. Hopefully, the details do not overwhelm you.
Medicare Supplement
(Medigap) and Medicare Advantage (Part C) plans came into existence because
insurance companies determined they could deliver health care more efficiently
than Medicare.
For senior health-care
services, the government sets aside approximately $700 per month. Insurance
companies said to the government, “Give us the $700 per month, and we’ll
provide better care and coverage than you can.”
If you choose Medicare
Supplement (Medigap), two entities will be billed for your medical services:
Original Medicare and the Medigap insurance provider. If your usage of medical
services is high, Medigap can be financially advantageous.
There is no
prescription coverage, so that must be purchased separately.
A majority of seniors
enroll in Medicare Advantage plans. The administrators of Advantage plans are
private insurance companies, but you still retain all of the rights and
benefits of Medicare.
An additional benefit:
Most Medicare Advantage plans include prescription coverage.
When you enroll in
Medicare Advantage, there are two core structure types. Your health care will
be provided by either a health maintenance organization (HMO) or a preferred
provider option (PPO). Both structures require you to receive your medical care
from providers within their networks; otherwise, additional fees apply. The
main difference: PPOs generally allow you to self-refer to specialists; HMOs
typically require primary-care physicians to make referrals to specialists.
Monthly premiums range
from $0 to $150. Deductibles, co-pays and out-of-pocket limits vary from plan
to plan.
Unlike Original
Medicare, all Medicare Advantage plans have out-of-pocket limits. Many plans
include the “Silver Sneakers” benefit: a no-cost gym membership. Determining
which plan is best depends on the frequency with which you anticipate needing
health-care services.
For a more detailed
look, it’s important to seek out the advice of a professional, independent
insurance broker who specializes in Medigap and Medicare Advantage plans. This
specialist can walk you through myriad options and help you choose the best
coverage for your current needs.
In the Seattle area,
the main providers of Medicare insurance plans are United Healthcare (the
nation’s largest provider; associated with AARP), Humana (No. 2 nationwide),
Premera Blue Cross, Regence Blue Shield, Group Health, Sound Health and
Community Health Plan, among others.
Open enrollment
The annual Medicare
open-enrollment period is from Wednesday, Oct. 15, through Dec. 7. If you have
no supplemental insurance and/or want to add prescription coverage, make these
changes during the open-enrollment period.
During the
open-enrollment period, assess your supplement, Advantage and/or prescription
plans to determine whether the insurance is providing the best value/benefits
for your current medical situation and prescription needs. If you are
dissatisfied, this is the time to change plans.
Coverage changes
become effective Jan. 1, 2015.
To explore coverage
options, go to the Medicare website:
www.medicare.gov/find-a-plan/questions/home.aspx.
Please note: The
Medicare plans described above are not part of the Affordable Care Act (ACA),
otherwise known as “Obamacare.” If receiving Medicare, do NOT apply for
supplemental coverage through the ACA via the Washington Health Plan Finder
website.
MARLA BECK is the
founder and president of Andelcare Inc., which provides in-home eldercare.
Submit questions by calling (206) 838-1844 or via e-mail to marla@andelcare.com.
J.R. Gillespie of
ALLSTAR Financial Insurance www.ALLSTARFinancialInsurance.com provided information for this column.
