Your Right to Health – The Medicare Solution

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Why Care?

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” This remarkable statement is found in the Constitution of the World Health Organization (WHO) as it was adopted nearly 75 years ago in 1946 in the devastating wake of World War II.

Many people, however, still debate whether health is a right or a privilege. Key to the debate is whether citizens should pay for each other’s healthcare.
The United States Constitution guarantees “certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” This has been interpreted to mean that United States citizens guarantee and accept a duty to care for each other.

Group Of Senior Friends Chatting At Home Together

Care for Whom?

The most vulnerable need the most care – and that includes the seniors who have worked the hardest for the longest time to keep America running. To address that, it has now been 50 years since President Lyndon Johnson signed Medicare, a health insurance solution for older Americans, into law on July 30, 1965.
Former President Harry Truman was the first American to sign up for the new Medicare program. He paid a mere $3 per month for this health insurance, but on the whole, everything else about Medicare seems to have taken giant leaps forward.

Today, Medicare also includes some younger people with disabilities and certain terminal diseases. Altogether, that’s nearly 60 million people — 52 million over 65 and 8 million younger.

Medicare, America’s national health insurance program, operates under the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS). Medicare covers about half of all healthcare expenses for those enrolled.

The Necessary Compromise

Medicare shares the cost of healthcare about 50/50 with the individual. Healthcare is seen as both a right and a responsibility of every American citizen, so the shared cost is a compromise between shared rights and personal responsibilities. See the Side Bar 1 on this page to see who pays and how, and Other Healthcare-related Costs on this page. As a result, Medicare enrollees almost always cover their half of the costs by:

Buying additional private insurance, and/or
Joining the conveniently bundled “Part C,” also called Medicare Advantage, offered by private insurance companies. It bundles Hospital and Medical Insurance (Medicare Parts A and B, respectively) and usually Medicare drug coverage (Part D), or
Doing nothing extra, the choice of about 1% of enrollees.

As simple as the Medicare concept is, there is so much variation in individual cases and annual updates, that Ben Lindquist, Individual and Senior Benefits Consultant, broker and advisor, in Jamestown, New York, advises, “The best plan is to work with a health insurance professional” to sort out the new benefits, conditions, restrictions, and any additional costs or savings that may apply with each alternative.

New News and Good News

Next year, 2021, like almost every year before, will see many changes to Medicare plans. There is some good news and there will be some challenges. The highlights listed below, however, are not an exhaustive list, but are meant to encourage Medicare beneficiaries to study all their options and consider seeking professional advice concerning the finer details.

Lindquist revealed to the Gazette, for instance, that Medicare will be rolling out some “exciting new programs” for 2021. A new insulin savings program has been developed in recognition of the fact that some patients may have been paying too much for their insulin, sometimes feeling forced to chose between medications and groceries or home heating.

Under a new provision of Medicare Part D it may be possible to pay no more than $35 per month for Insulin. This will, however, require the advice of a physician because not all insulin brands or formulations will be covered.

In addition, Lindquist says, the infamous and dreaded Part D “Donut Hole” will no longer exist in 2021. That is the coverage gap in prescription medication costs between the initial coverage limit and the catastrophic-coverage threshold. A standard plan’s maximum deductible, however, will increase to $445 in 2021. The threshold for entering the catastrophic coverage phase will increase to $6,550, but here out-of-pocket spending [aptly called OOPS] will decrease significantly.

Another new Medicare feature for 2021 is the addition of an over-the-counter (OTC) benefits card that will cover between $100 and $120 for the year to cover vitamins, nutritional supplements, and related non-prescription agents. This will be an addition to some Medicare Advantage Plans.

Improved coverage for some specialized medical needs will also be available in 2021. Medicare Advantage plans are available, for instance, for people under care for ESRD (End-Stage Renal Disease). For more information, visit www.Medicare.gov/publications to see the booklet “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services.”

Medicare also now covers up to 12 acupuncture visits for chronic low back pain treated over a period of 90 days.

Fortunately, Medicare enrollees still have plenty of time to review 2021 Medicare plan options during the annual Open Enrollment Period that continues through December 7, 2020.

For more information, Medicare clients can call Medicare at 1-800-633-4227 and speak with a Medicare representative or go to www.medicareresources.org to see how Medicare benefits are changing for 2021.
Other PlanChanges

If a particular 2020 Medicare plan is being terminated in 2021, and some are, and if enrollees are not merged (called “crosswalked”) into another 2021 Medicare plan, they may be without Medicare plan coverage on January 1, 2020. Nevertheless, Medicare Advantage enrollment is expected to continue increasing overall to a projected 26 million citizens.

According to Q1Medicare.com, Education and Decision Support Tools for the Medicare Community, “If you decide to stay with your current 2020 Medicare Part D or Medicare Advantage plan into 2021 – AND you understand how your Medicare plan is changing – you do not need to do anything – you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for 2021.”

Some premiums and co-pays are slated to increase in 2021, and Medigap Plans C and F will no longer be available for purchase by newly-eligible Medicare beneficiaries.

For the most authoritative and complete coverage information, however, Lundquist advises Medicare beneficiaries to visit www.Medicare.gov , to compare plans, health care providers and services. To further compare health and drug plans continue on to www.Medicare.gov/plan-compare . This background, combined with professional assistance, is especially advised for newcomers to Medicare.

Personal Experiences

“When I started Medicare, I felt relieved, comforted, that if I need help with my medical costs, Medicare was there for that,” Jamestown Gazette reader, Marie J. said. She also noted that because she had already been a recipient of Social Security Disability (SSD) benefits, she was automatically enrolled in Medicare Parts A and B on becoming 65 last year.
Marianne S. of Falconer, New York, has been enrolled in Medicare for 15 years. “It’s changed in quite a few ways over the years, but usually for the better. It’s a Godsend for me and my husband.”

More Resources

Medicare has prepared a helpful booklet now available online titled “Medicare & You 2021 – The official U.S. Government Medicare Handbook” ( www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf ).

Newcomers to Medicare or long-time enrollees are invited to call Social Security at 1-800-772-1213 for more information about Medicare eligibility and to sign up for Part A and/or Part B. TTY users can call 1-800-325-0778. People who worked for a railroad or get RRB benefits, can call the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701.

Free, personalized health insurance counseling is also available at the State Health Insurance Assistance Program (SHIP). In New York, that is the Health Insurance Information Counseling and Assistance Program (HIICAP) 1-800-701-0501.

The Jamestown Gazette wishes health and safety to all of our readers and is pleased to help our readers stay on that path with this information about the vital benefit of Medicare and its related insurance programs.

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Walt Pickut
Walt Pickut’s writing career began with publishing medical research in1971 while working at the Jersey City Medical Center and the NYU Hospital and School of Medicine. Walt holds board registries in respiratory care and sleep technology as well as bachelor's degrees in biology and communication, and a master's degrees in physiology from Fairleigh-Dickinson University in New Jersey, with additional graduate work in mass communication completed at SUNY Amherst. He currently teaches Presentational Speaking in the Houghton College PACE program at JCC and holds memberships in the Society of Professional Journalists and the American Society of Business Publication Editors. He lives in Jamestown with his wife Nancy, an MSW social worker, and has three children: Dr. Cait Lamberton in Pittsburgh, Bill Pickut, a marketing executive in Chicago, and Rev. Matt Pickut in Plymouth, IN.