Submitted by Bedford at Home
Have you ever wished that Medicare would just be Medicare? That is not today’s reality. Back in 2005 under then President George W. Bush, Medicare underwent a tremendous change. His administration expanded Medicare from the traditional red, white, and blue card to add the option of private companies offering plans. These plans were termed Medicare Advantage, or Part C plans, and some offered additional services such as vision and dental. They were required to provide essentially the same services as original Medicare and, many times, these could be offered at a lower cost. The system has grown in complexity since.
Many people are confused as to how and when they can make changes. Here is a testimony as to how complicated Medicare changes can be:
Imagine you have started a new job and the company lays out all the insurance benefit information for you. There are no instructions, and your Human Resources representative is of no help. The coverage appears to be all the same, but the premiums are different. Would you be confused?
Now, imagine you are 75 years old or older, with maybe the beginning of dementia. You have worked your entire life, and you are staring at information provided by Medicare. There are varying plans with varying prices, but most look the same. Would you be frustrated?
This frustrating and time-consuming process was one that I recently went through with my own grandmother. She was paying almost one-third of her Social Security income on Medicare supplement premiums. We had to find a better solution. We went on an adventure through Medicare and Medicare Advantage plans. After all, I am a registered nurse working in long-term care; what could be so difficult about it all?
What we found was heartbreakingly frustrating for me and hopeless for my grandmother. There were no operators at the toll-free numbers who could answer our questions. There were no answers on the websites. It was a process of piecing together fragmented information from various places to form a decision. After many, many hours of studying websites and multiple phone calls, we made a choice.
Thankfully, my grandmother has someone to oversee her affairs, but many elderly do not. No matter the circumstances, we as a community must do better for our aging population. These people worked entirely too hard and too long to go blindly into these decisions.
Here are some Medicare explanations in a nutshell:
Original Medicare Part A, or the hospital component, usually is provided at no cost to the beneficiary. Original Medicare Part B — or the physician, lab, home health, etc. component — comes with a premium. Most currently pay $135.50 for Part B. Both Parts A and B can come with higher premiums, depending on the beneficiary’s adjusted gross income for two years prior. A separate Part D drug plan is needed if the beneficiary wants coverage for prescription drugs. Medicare Part C is an umbrella coverage that usually rolls Parts A, B, and D into one plan for one premium. Many times, this single premium will save money when compared to $135.50 for Part B, plus a separate Medicare supplement plan that usually ranges from $150 to $300 monthly, and a Part D plan that usually ranges from $20 to $100 monthly.
In Mississippi, only three companies offer private Medicare Advantage plans. They are Cigna-Healthspring, Humana, and WellCare. There are individuals whose Medicare Advantage plan is a part of their retirement package, and that coverage can be with Aetna, United Healthcare, Blue Cross, or other companies.
So, what’s new in 2019?
According to the Centers for Medicare and Medicaid services (CMS), a new Medicare Advantage Open Enrollment period will run from January 1 to March 31 of each year. Any changes you make will be effective the first of the month after the plan gets your request. During this period, beneficiaries will have the opportunity to take the following actions:
- Switch to a different Medicare Advantage plan.
- Return to original Medicare Parts A and B.
- Sign up for a stand-alone Medicare Part D plan (This one requires the beneficiary be in a Special Enrollment period. See the 2019 Medicare and You Handbook for these). Remember that enrollment in a Medicare Part D plan will automatically return the beneficiary to original Medicare, and a Medicare supplement may not be available, or may be cost prohibitive and have limitations and exclusions set by the plan.
There is much assistance available to answer questions and help you choose the best plan. Each state has a State Health Insurance Program (SHIP). The number for this area is 1-800-444-8014. Each private company — Cigna-Healthspring, Humana, and Wellcare — also offer toll-free numbers to provide information and enrollment or dis-enrollment assistance.
A wealth of information is available at the Mississippi Insurance Department website: www.mid.ms.gov. Resources include the MID Medicare Supplement Shoppers Guide and Medicare Advantage Scams: Tips on How to Avoid Becoming a Victim. This reminds us that Medicare Advantage plans are sold by private companies, and we do need to avoid high-pressure sales techniques.
Any change in Medicare plans needs to be made after adequate research and with the peace of mind of knowing the right decision was made based on the individual’s needs, income, and circumstances.
Written by Angela Barnett, MSN, RN, Training and Development Coordinator for Bedford Care Centers and Barbara Ellington-Lofton, Resident Benefits Specialist for Bedford Care Centers. They can be reached at 601-450-3744.
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