If you are 65 or better — or nearly there — you have undoubtedly heard a lot about Medicare, the health plan for seniors and some disabled people. And you likely have a lot of questions about it, too.
On Nov. 19, the Inquirer will host a one-hour panel discussion with two Medicare experts, James Long (an independent insurance broker and certified senior adviser based in Norristown) and Christine McBennett (director of Philadelphia's APPRISE, a free and objective Medicare counseling service). They will speak with Inquirer health and science editor Charlotte Sutton about the Medicare issues they hear about most, and also will answer audience questions.
To preview that discussion, Long and McBennett have answered a few questions they often field from people enrolling for the first time, and those who may want to change coverage during the annual open enrollment season, which ends Dec. 7:
I'm almost 65, but I am still working at a job that offers health insurance, and plan to continue for a few more years. Do I need to do anything now about Medicare?
You may consider enrolling in Medicare Part A, unless you contribute to an HSA (health savings account). Part A, which covers hospital care and some other services, can help pay for hospital charges after your employer's plan, and there is no monthly fee for most people. Typically, people in your situation are free to delay enrollment into Part B (which covers physician visits, lab tests and other medical services) and Part D (prescription medicines) until retirement, without penalty. If you work for an employer with fewer than 20 employees, your company's insurance carrier may require you to enroll in Medicare A and B to continue paying claims.
How do I know whether I should get a Medicare Advantage or Medicare Supplement plan?
Though it's possible to switch between traditional Medicare plus a supplemental plan, and a Medicare Advantage plan, try to make your decision as if you had to pick the medical insurance you wanted for the remainder of your retirement. If you think you will want the broader range of health-care provider choices permitted by traditional Medicare (as primary) and a supplement policy to cover out-of-pocket expenses, you should buy one when you are new to Medicare Part B. This is when you are exempt from medical underwriting. If you like coverage similar to what may have been provided from your employer (an HMO or PPO with lower out-of-pocket costs, a defined network of providers, and copays for most services), Medicare Advantage may be for you.
Some of the plans have star ratings. What do those mean?
Medicare measures Part C (the other name for Medicare Advantage) and Part D plans in 47 performance categories. Many of these categories are based on how well the plan manages the care of members. For instance, do high rates of members get all their preventive services and refill critical medications? Other categories have more to do with how well and often the plan communicates with members and the number of complaints filed against the plan.
I know it's open-enrollment season, but I like the plan I have. Can't I just keep it?
Generally, unless your insurer has notified you that it is shutting down your plan at the end of the year, it will auto-renew, even if you do nothing. However, you should carefully review the changes your plan is making — for instance, a medication that is covered now won't be covered next year — and compare it with other available plans. There could be a plan next year that you would like even more than your current one or may be more cost-efficient, depending on your health needs.
I'm on a fixed income and I'm having a really hard time paying my premiums. Does Medicare have anything extra for people like me?
There are state and federal programs that help lower costs, if you qualify. In Pennsylvania, the State Pharmaceutical Assistance Program is called PACE and is for people earning less than $23,500 per year. Assets are not counted. Through Social Security, depending on your income and assets, you may qualify for the Extra Help program to help pay for Part D premiums and lower prescription copays. Social Security can also send your application back to your state to see whether you may also qualify for the Medicare Savings Program, which may pay your Part B premiums and more.