Medicare seminar presented at American Legion Post #136
Wednesday morning about 25 people arrived at the St. James City American Legion Post #136 for the second annual Medicare educational seminar.
Commander Tom Lewis introduced Kathy Thousand from Insurance Options.
“This is just an introduction to the Medicare program,” Lewis said. “There are some things you need to know, some things you should know but no one is here to sell you anything. This is purely educational.
“This is Medicare 101, just educational, no strings, just information,” Thousand said, “I am a licensed insurance agent since 1997 and I am with Insurance Options. We help people make insurance choices.”
“Original Medicare” was created by Congress in 1965 as the traditional fee-for-service program offered directly through the federal government.
“Medicare provides insurance to people 65 years of age or older or people with certain disabilities recognized by Social Security,” Thousand said. “You can see any doctor and hospital that takes Medicare anywhere in the country. Baby Boomers are signing up for Medicare at 10,000 per day.
“‘Original Medicare’ consists of two parts: Part A and Part B,” Thousand continued. “Part A helps with your hospital, skilled nursing, home health care and hospice. Part B helps with doctors in and out of the hospital, preventive services, diagnostic testing and DME (durable medical equipment such as canes, crutches, hospital beds etc.).”
In addition to Parts A and B, there is also Part C, sometimes called Medicare Advantage Plans. These are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Part D adds prescription drug coverage to your Medicare plan through private insurance company.
“Part A is free for everyone that has worked at least 40 quarters (10 years) or qualifies under their spouses benefit,” Thousand said. “Part B is for doctors and outpatient coverage. This is not free. The average cost is $121.80 and is automatically deducted from your Social Security check. There is a penalty if you decide later to sign up for Part B.”
The Part A deduction is $1,288 and covers a semi-private room and board (not doctors) for stays up to 60 continuous days. After 60 days the hospital charges $322 per day. At 90 days that adds up to $9,660. On the 61st day there is a “Lifetime Reserve Days” provision where the hospital can charge $644 per day.
“Part A has a skilled nursing provision that covers things like rehab,” Thousand said. “This coverage has a 3-day hospital stay requirement and up to 20 days at a skilled nursing facility.
“Part B covers doctors, blood work, diagnosis, etc.,” she said. “There is an annual deductible of $166 and Medicare pays 80 percent of the bill.”
Thousand suggests making the correct choices when you sign up for Medicare.
The coverages choices are:
Original Medicare with or without added prescription coverage.
Original Medicare with a Medicare Supplement (aka MediGap) with or without added prescription coverage
Choose to receive all your Medicare benefits from a private insurance company that has an annual contract with Medicare, called an Advantage Plan, with or without drug coverage.
Employer or Retiree Plan.
“If you feel your family is healthy and you don’t want to spend the extra money, you can just sign up for Medicare Part A,” Thousand said. “Most Americans wind up paying the lowest premium for Part B and some add the prescription coverage.”
There are 11 standardized Medicare supplement plans: A, B, C, D, F, G, K, L, M & N. Plus High F. Each plan provides the same coverage regardless of the carrier, require a monthly premium based on age, ZIP code, gender, etc. Most have a prescription plan built in.
“Medicare Advantage Part C plans are run by private insurance companies who have an annual contract with Medicare,” Thousand said. “These plans can change annually. There are HMO (Health Maintenance Organization) plans; PPO (Preferred Provider Organizations); SNP (Special Needs Plans. Applicants must meet eligibility requirements.”
Prescription Drug Plans are under Medicare Part D. These benefits are available to all people with Medicare and requires Part A and/or B. They are provided through stand-alone Medicare Prescription Drug Plans, Medicare Advantage Plans and some employers or unions. Premiums can range from $15 to $100 per month.
“For those that choose to opt out of the drug plan when they sign on to Medicare and wait, say 10 years,” Thou-sand said, “there is a penalty that is to be paid as a monthly premium. Once the government fixes your penalty you will pay that for the rest of your life. Over a 20 year period this could add up to more than $8,000 in penalties.”
The Initial Enrollment Period (IEP) for those new Part B (turning 65 for example) lasts for 7 months. Three months before the birth month, the birth month, and three months after the birth month. Coverage begins no earlier than the first day of the eligible month. For Part C Advantage Plans & Part D prescription drug plans is from October 15 through December 7. Coverage begins Jan. 1.
Thousand also answered questions from those in attendance.
Question: “If I want to make changes to My Advantage or Drug plan when, can I do that?”
Thousand: “The window for changing your benefits is from Oct. 15 through Dec. 7.”
Question: “What about dental and vision programs?”
Thousand: “Those are only available through private insurance.”
Question: “Are the cost increases of Advantage Plans limited in any way?”
Thousand: “I assume the government limits those costs but I’ve never dealt with that before.”
Question: “When can I disenroll from Part C?”
Thousand: “That can be done from Jan. 1 through Feb. 14.”
“Just so you know, we will be having another Medicare 101 session on Thursday, Nov. 3, at 11 a.m.,” Thousands said, “in case you didn’t understand all of this or you have friends or neighbors that were unable to come today. If you have any additional questions please call my office.”
Thousand’s Insurance Options is at 1401 Viscaya Parkway, Unit 2, in Cape Coral. Call 239-201-4560.