By Joan Koczor

Joan Koczor

Open enrollment in Medicare begins Oct. 15.

Rebecca Jennings, program director for Medicare from Pinal Gila Council for Seniors, will give a presentation about Medicare on Oct. 23 at Maricopa City Hall from 10 a.m. to 2 p.m.

On July 30, 1965, as an amendment to the Social Security Act of 1935, President Lyndon B. Johnson made Medicare law by signing H.R. 6675 in Independence, Missouri. Former President Harry S. Truman was enrolled as Medicare’s first beneficiary and received the first Medicare card. Johnson wanted to recognize Truman, who, in 1945, became the first president to propose national health insurance, an initiative opposed by Congress at the time.

Medicare is a single-payer, national, social insurance program administered by the federal government. Coverage for this program became effective in 1966. Some 19 million people enrolled in Medicare when it went into effect in 1966

Many people are already enrolled in Medicare, and many of you may be eligible for coverage beginning in 2018.

To better understand what open enrollment is about – before you make any major changes to your existing coverage – here are a few of the plans offered:

Medicare Part A (Hospital Insurance) Costs. Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $413 each month.

Medicare Part B (Medical Insurance) Costs. The standard Part B premium amount in 2017 is $134 (or higher depending on your income). Most people who get Social Security benefits pay less than this because the Part B premium increased more than the cost-of-living increase for 2017 Social Security benefits. If you pay your Part B premium through your monthly Social Security benefit, you pay less ($109 on average). Social Security will tell you the exact amount of your Part B premium.

Medicare Advantage Plan or Part C. If you have Medicare Advantage or Part C, take a few minutes to review your coverage as plan benefits can change year to year. Before open enrollment begins, you should receive an Annual Notice of Change, which provides any changes in your Medicare Advantage plan’s cost, benefits, provider network and other rules as they apply to the coming year. At this time, you can change plans or switch back to Medicare Part A and Part B. Keep in mind if you do switch back, consider a Medicare Supplement to cover what Medicare doesn’t.

Medicare Advantage Plan or Part D. At this time, you can switch your Part D or Medicare Advantage Plan. Also at this time you should receive an Annual Notice of Change. Please review it carefully as drug formularies can change each year. A drug covered in 2016 may not be covered in 2017.

If you are satisfied with your current Medicare coverage you need to do nothing. However, at this time you can explore what other coverages are available and if they better serve your needs.

A trained – and trusted – insurance professional can provide detailed information about the Medicare plans available, answer any questions or concerns you may have and explain other options that may work better for you.

Information is out there – just ask or go online.

Medicare2017.org, Medicare.gov


This column appears in the October issue of InMaricopa.


Medicare or Medicare Advantage

Medicare Advantage plans (sometimes called Medicare Part C) are offered by private insurance companies as an alternative to traditional Medicare. Their insurance benefits cover the same services as traditional Medicare Part A and B, but some plans also offer prescription drug coverage (Part D). Medicare Advantage plans may have slightly different (usually lower) costs and out-of-pocket expenses; some plans charge an additional premium. Access is often more restricted because these are HMO or PPO plans, i.e. you may not be able to see all providers under a Medicare Advantage plan that you can under Medicare. First-time enrollees are automatically enrolled in traditional Medicare but may choose to switch to a Medicare Advantage plan at the time of enrollment or annually after that.

Medicare v. Medicare Advantage
Medicare Medicare Advantage
Overview Medicare in the U.S. is an insurance program that primarily covers seniors ages 65 and older and disabled individuals of any age who qualify for Social Security. It also covers those of any age with end-stage renal disease. Medicare Advantage, sometimes known as Part C, is a private insurance alternative that replaces “Original Medicare” Parts A and B. Some Medicare Advantage plans even cover prescription, or Medicare Part D.
Type of program Government-run Private
Eligibility Regardless of income, anyone turning 65 can enroll in Medicare so long as they paid into Medicare/Social Security funds. People of any age with severe disabilities and end-stage renal disease are also eligible. To be eligible for a Medicare Advantage plan, a potential subscriber must already be eligible for Original Medicare, pay the monthly Part B premium, and not have end-stage renal disease.
Services Covered Routine and emergency care, hospice, family planning, some substance and smoking cessation programs. Limited dental and vision. Everything covered by Original Medicare. Also often covers prescription drugs and may cover dental, vision and hearing. May have special preventive care coverage, like gym membership.
Cost to Enrollees Part A costs nothing for those who paid Medicare taxes for 10 years or more (or had a spouse who did). Part B in costs $109 per month for most on Social Security. Part D costs vary, usually around $30 per month. Medicare Advantage costs vary. Must pay Original Medicare’s Part B premium, plus — usually — a monthly Medicare Advantage premium (approx. $30-$65). Likely required to pay a copay to visit a doctor. Coinsurance costs vary.

 

 

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