Originally Published: November 28, 2016 6:02 a.m.
The deadline for Medicare open enrollment is Dec. 7.
Some Medicare recipients, senior citizens 65 and older, may need to take no action.
If satisfied with the current Medicare plan, be it the traditional hospital and medical coverage combined with a Medicare prescription drug plan, a Medigap supplement plan or the alternative Medicare Advantage plan, people can simply allow that plan to remain in place. The new plans go into effect Jan. 1, 2017.
• The official Medicare website is www.medicare.gov or obtain information by calling 1-800-Medicare.
In northern Arizona, Medicare-eligible individuals can call The Area Agency on Aging in Flagstaff at 1-877-521-3500.
• Area Walmart’s are offering in-store assistance through the enrollment deadline of Dec. 7. Walmart offers their own Medicare Part D prescription plans.
UnitedHealth Care will be offering meetings in the area to discuss its various plans:
Nov. 30 – 11 a.m. at the Willow Creek Restaurant, 2516 Willow Creek Road; Dec. 1 at 11 a.m. in Prescott Valley at Garcia’s Mexican Restaurant, 2992 N. Park Ave., Dec. 2 at 2 p.m. at the Chino Valley Bonn-Fire Restaurant, 1667 State Highway 89.
• Each state also offers what are called SHIPS, the State Health Insurance Assistance Program. SHIPS are non-profit organizations that help people with Medicare understand their benefits, with free personalized counseling. The Arizona number is 1-800-432-4040.
With all the twists and turns in health care, however, state, local and national specialists suggest all Medicare recipients at least take a look at their plans to be certain it provides the insurance they require based on their health and prescription needs, and costs related to household income. Patients will also want to be certain their physicians accept their Medicare insurance and any supplement plans.
Like with any health insurance, there is no one-size-fit-all plan.
Medicare is a federal insurance benefit intended for senior adults, with Part A that provides for in-patient hospital coverage, skilled nursing facilities and hospice care with a no-premium cost for those who have paid into the system over the course of their working careers. For others, Part A is available at a cost of $411 a month.
Part A is then combined with Part B that is a premium-based medical insurance, covering 80 percent of medical costs, such as doctor’s visits, outpatient therapy and medical equipment. The standard Part B premium for 2017 for those who earn less than $85,000 a year is $134 a month. Medicare Part D is the prescription drug coverage offered through a variety of different, endorsed plans based on individual prescription needs. In 2017, the Part D standard plans have a $400 deductible and 25 percent coinsurance up to an initial cover of $3,700 in total drug costs, according to federal Medicare specialists.
Beyond these standard Medicare plans, eligible men and women can select Medicare Advantage plans (Medicare Part C) offered through private insurers that offer a combination of Part A, B, D and other benefits with various premium costs. In Yavapai County, the only two private insurance companies now offering Medical Advantage plans are United Health Care and Humana.
An example of cost: United Health Care will charge a $46 a month premium with $10 co-pays for primary care physician visits and $40 co-pay for specialist visits.
For those who want to buy supplements to help cover the balance of their health costs beyond traditional Medicare reimbursement, there are a variety of Medigap policies that can assist with deductibles and co-payments. Supplements, however, are not able to be used toward prescription costs.
The multitude of choices for Medicare patients can be confusing, but with proper direction and research recipients can craft a health insurance package that not only meets their health care needs but does so at an affordable price.
National Medicare specialist Cate Kortzeborn, who beyond her duties as an acting regional administrator that includes Arizona writes articles related to Medicare issues, said she advises friends, family and others to annually consider their health care needs as they select plans, particularly Medicare Advantage and prescription plans, to be certain they will have adequate coverage.
These plans may alter on an annual basis their premiums, what drugs or services they will cover, and doctors may elect to accept or reject certain plans based on their reimbursements, Kortzeborn said.
“Shopping among the numerous plans, and choosing the right one, could mean saving hundreds of dollars a year,” Kortzeborn said in a news release.
Local Medicare insurance specialist Patti McCormick said the best advice she can give to anyone is to work with a qualified agent to select a plan that best suits the individual.
The Prescott area has several insurance agents and firms that are very familiar with Medicare and the various options and alternative Advantage plans and how those can be combined to address a client’s need. Medicare has a good website – www.medicare.gov – but McCormick said even that information can prove overwhelming to a person so working with an agent can help them boil down the options and costs.
“Choose your agent as carefully as you choose your plan,” McCormick advised. “A good, independent agent can look at all of your choices and find what’s best for you. A good agent will look at whether you qualify for federal assistance and help you apply. They will look at all your medications, and make sure all of your doctors are in-network, or look at plans with no network.
“And I highly recommend going with someone local.”
Seminars can be good for general information, but local agents will be available throughout the year to answer phone calls when questions arise. People should consult with their neighbors, friends and family about agents they have used and trusted with their Medicare needs, she said.
“When you have difficulties, you don’t want to just be told to call 1-800,” McCormick said. “Anyone (licensed agent) can write a Medicare insurance policy. But you want someone that services the policy well.”