Medicare: What You Need To Know


Article Contributed by
Joni Blackman

We are all hearing about the current “open enrollment” period that starts October 15 through December 7, 2019. This open enrollment period is for managing the drug prescription part of your Medicare, called Part D, and any changes you need in your Medicare Advantage program which includes a Part D. What about the rest of your Medicare plans? Let start from the beginning.

You need some facts first before you sit down with local counselors, either those that are trained staff with the Office for the Aging or other non-profit agencies or a broker that is associated with an insurance office. All the counselors are trained by the State and certified. The non-profit agency counselors are unbiased. The brokers are paid from the products they are presenting. Both are good and reliable.

Initial enrollment and a quick primer

Your initial enrollment happens three months prior and after your 65th birthday. If you don’t enroll in that six-month window there is a penalty. OK, so once you have the enrollment timeframe covered, then what? Confusion sets in once you see the various moving parts to Medicare; Part A, Part B, Part C or Medicare Advantage, Part D and Medigap!

Part A helps pay for the cost of inpatient stays in hospitals and short-term skilled nursing facilities, home health services and hospice care.

Part B helps pay for doctors’ services (including those in the hospital), outpatient care (in or out of a hospital), diagnostic tests, preventive care and some medical equipment and supplies.

Part C, or Medicare Advantage, is an alternative coverage option to original Medicare that allows you to choose to receive your Medicare health care benefits through one plan. These plans must cover all Part A and Part B services, and most include Part D drug coverage. Some plans also provide extra benefits that original Medicare doesn’t offer.

Part D helps cover the cost of outpatient FDA-approved prescription drugs.

Medigap insurance, which is sold by private companies, helps pay for costs that Medicare doesn’t cover, such as copayments and deductibles. Medigap coverage is available only to people who have Medicare Parts A and B, not Part C or Medicare Advantage. Medigap Insurance comes in a plan, and you can only choose one plan.

How do you know what you need?

Every person has unique needs. The process of enrolling and updating your Medicare programming is not simple. It is a puzzle of needs and options that will come together to keep you healthy and give you a good quality of life.

A few of the guestions you should ask yourself are:

1. Will I remain in my home or in this area for the majority of next year? If yes, then you can research bundling Part A with Part B and D, commonly called Part C Medicare Advantage, because you will be in the same place to use the network you chose.

2. If you are planning on traveling the country and not staying in one place for very long, then you want to keep Part A and B separate and add Part D which will be included in a Medigap Plan that meets your needs based on any other supplemental health care coverage you are also using.

3. You will need to know your pre-existing conditions such as high blood pressure, diabetes, etc. before you can pick a plan that will work best for you.

4. Next, what are your prescription needs? Part D is all about the drugs you are using. Make sure you have a list with you when you visit the website or a local counselor who can help you chose the plan right for you.

This is not a quick process. It takes time and research to find the best plan, but it can be done. There are plans available that fit the majority of the 65+ population. The secret to getting the best coverage that you can afford is to know what you need covered and asking questions to make sure you understand what you are signing up for. If you find the plan you chose is not suitable you can change it. The times open for the change you need depends on your situation. The information is available on the website, and through the various agencies assisting the elderly.

Christine Chronios who administers the HIICAP program for Chautauqua County said, “It is best to use a trained counselor to find the best programs for each individual. The website was revamped and released just a few days ago. We, the trained counselors, are working hard to learn how to use the website. Ideally the website should empower individuals to learn about Medicare and understand what they need and how the Medicare programs work for them. The website is daunting, but if one takes the time to learn to use it, it is a powerful tool for information.”

What is the cost?

Most people who qualify for Medicare don’t pay a monthly premium for Part A because they paid for it through payroll taxes while working. There are premiums for Part B and Part D or a Medicare Advantage plan. Part B premiums are income based to be affordable. Part D (drug coverage) costs are forecasted to be less in 2020. The Medigap premiums are across the board, depending on which plan you chose from which private company.

People with limited incomes may be eligible for assistance paying their Medicare premiums, deductibles and cost sharing. The program that helps with these costs is called the Medicare Savings Program (MSP). Another assistance program unique in NY is the Elderly Pharmaceutical Insurance Coverage Plan or EPIC. There are many non-profit agencies that help with the MSP and EPIC applications.

Coverage for All

Everyone 65 and over is covered by Medicare. It all depends on your individual needs as to what coverage you chose. It is important to keep up to date with the annual updates to your plans, especially if you move out of your Part C (Medicare Advantage) network or change prescriptions.

Retirement is full of changes. From your day to day schedule to your medical needs. Don’t let the initial work of setting up your Medicare needs spoil your golden years.