seniors

Hooray, Medicare time!

A boring but really important story

By ANNEMARIE SCHUETZ
Posted 11/18/20

Once upon a time, but very recently, people in the US turned 65 and became eligible for Medicare.

They knew because they had many more phone calls that they may or may not have screened. They knew …

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seniors

Hooray, Medicare time!

A boring but really important story

Posted

Once upon a time, but very recently, people in the US turned 65 and became eligible for Medicare.

They knew because they had many more phone calls that they may or may not have screened. They knew because their mailboxes broke under the weight of Medicare information.

In fact, some of us who are nowhere near 65 (and, in fact, members of Gen X will have to wait till age 67 for full benefits) have been receiving Medicare info, which we also did not read.

This story is also for those who are younger and disabled, or those caring for an older person and slogging through their Medicare mail.

It’s a primer on a (mostly) government-run service that has changed the lives of our elderly and disabled.

Medicare, aka original Medicare

Medicare is different from regular health insurance. It’s divided up into parts that cover different services.

Part A covers hospital stays, a limited number of days in skilled nursing, hospice care and some home health care. You most likely won’t pay a premium for this, but there’s a deductible for inpatient stays.

Part B covers certain medical services, like diabetes and kidney care, blood work, EKG tests and more. Part B has a premium to pay. (To see what else is covered, visit www.bit.ly/hhsmedicarepartb).

Part D covers prescription drugs and shots.

Always read the paperwork or have a friend or family member do it. Make sure you know what you’ll have to pay, whether it’s premiums or copays or coinsurance. How much of a regular doctor’s visit will you pay for? Read, and if you’re not sure, ask your doctor. (You can also investigate contacts below.)

But wait, there’s more!

Medicare Advantage: Read before you leap

Medicare Advantage (MA) is an alternative to regular Medicare that is run by private companies. It usually covers more than original Medicare does, and if you sign up for one “you still have Medicare,” says www.medicare.gov. You’ll get Part A, Part B and. usually (but not always!), Part D.

Even with extra coverage, you may pay less than you would on Original Medicare—but there are buts.

Advantage plans differ, so you need to read through the list of what’s covered before you sign on.

Basically, treat MA plans like you would regular insurance. You might have co-pays and/or co-insurance, so that’s something to keep in mind as you shop for plans. You might have a deductible.

MA has networks, like regular insurance. Make sure the doctors, pharmacies and hospitals you like are in that network. “Network adequacy” is something to watch as plans try to cut costs.

And please, please make sure your meds are covered.

One good thing about MA plans is that they have an out-of-pocket maximum. You won’t have to pay more than that maximum on covered services. (Emphasis on covered services. Things that aren’t covered don’t apply to the out-of-pocket maximum.)

How about alternative medicine?

Medicare will pay for some acupuncture to treat chronic lower-back pain, but that’s about it. Some MA plans will cover more treatments, including acupuncture for fibromyalgia and, supposedly, even CBD.

Money, honey

Medicare costs money, you may have realized. The days of free health care through it are mostly gone. Even when they do pay the full cost, time is limited. For example, you only get 100 days of skilled nursing care within a benefit period.

You will have premiums, deductibles, copays and co-insurance (that’s a percentage of the cost of treatment that you have to pay.)

MA plans, which often bundle Medicare services with other covered treatments, might cost you less than original Medicare by itself.

If you can’t afford it, you might be eligible for subsidies. You might qualify for Medicaid, too. Call the agencies in the contact box below.

Signing up

When you turn 65 (or if you’re younger and disabled), you’re eligible. You can sign up for Parts A and B three months before you turn 65 and three months after. You can also sign up for MA then.

If you don’t sign up until your birthday (or three months after), your Part B might be delayed, according to www.medicare.gov. If you’re late, you might have to pay a late-enrollment penalty.

There’s a general enrollment period between January 1 and March 31, but, again, you might have to pay a penalty. That’s when you sign up for Original Medicare.

There’s currently an open enrollment period that is open until Monday, December 7. You can sign up then (aka “now”) for Medicare Advantage.

Contact info

In Wayne County, you can contact the Area Agency on Aging with your questions: 570/253-4262.

In Sullivan County, call the Office for the Aging: 845/807-0241.

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