Help Navigating Medicare Open Enrollment Oct 15th – Dec. 7th

By Marilynn Huseby, Senior Resource Consultant

October 2019 | San Juan Silver Stage | By Marilynn Huesby, Senior Resources Consultant ]

In this electronic age, it can be daunting to find easy-to-understand information on all the questions you have about “How to Compare Medicare Supplements with Advantage Plans and Find the Best Medicare Part D Prescription Drug plan.” In 1966, Medicare became the health insurance provider for older and disabled Americans. Since then, Medicare now provides coverage to 58 million Americans and has become more complex with enrollees facing ever more choices. Americans 65 and older or entitled through disability have to make their Medicare Open Enrollment choices.

Open Enrollment

It’s important to consider your health care needs and your prescription needs during this period as THESE PLANS CHANGE A LOT FROM YEAR TO YEAR. To help you get started, here are some main points in researching and making decisions right for your own health and prescription drug needs.

Medicare Part A

Medicare Part A is free to most people who qualify for Medicare because they paid into Social Security for the period required to qualify or are a spouse of a qualified person. After your deductible of $1,364 (for 2019) is paid, Medicare Part A pays for hospitalization—provided you stay in the hospital for three days or more: in full for the first 20 days, then in part with co-pays up to 100 days in the hospital; after that, the patient is responsible for payment. Hospice care is covered at 75% and is paid when your doctor says you have 6 months to live; the hospice benefit can be extended as long as you live. These are fairly clear-cut benefits with the consumer knowing how to ask some basic questions.

Medicare Part B

Part B covers all services other than you being in a bed. Included are doctor office visits, out-patient surgeries, physical therapy, diagnostic testing, and durable medical equipment. Medicare Part B has a monthly premium of $135.50. After the annual deductible of $185, Medicare pays 80% of the services and the enrollee is billed the remaining 20%. This is called the “Gap” and people have different supplemental or gap policies.

Part B, Supplemental “Gap” Policies

These policies have been standardized—meaning that every supplemental company offers the same policy choices from A through N. They range in price from $33, $50, $80, $120, to $200 a month. These are choices that can be customized to your needs and DO NOT fall into the Medicare’s Open Enrollment period. Comparing these “Gap” coverage’s to Advantage Plans IS REALLY important. Most people really do not realize how much original Medicare covers with the right supplemental policy.

Medicare Part C

In 1997, Medicare created Medicare Part C, or what is known today as Medicare Advantage Plans. These plans offer BENEFITS EQUAL to Medicare but managed by a private insurance company approved by Medicare. Unlike original Medicare, these plans use a network of health care providers from Doctors to Hospitals. You must use the providers in these networks to receive benefits equal to Medicare. If you are out of their service area because of travel, this may be highly problematic.

On the Western Slope, there is one Advantage Plan with Humana and a Choice Advantage Plan with Rocky Mountain Health plans. These plans have deductibles and co-payment that are equal to Medicare’s. They may charge an additional premium or not as Medicare subsidizes these plans. Medicare saves money when you assign your benefits to an Advantage Plan to manage your care. Here is the first big choice to be aware of the Pro’s and Con’s. These are choices that are available during Open Enrollment.

Medicare Part D

Medicare Part D was created in 2003 to provide low-cost plans that cover prescription drugs. If you chose not to enroll in a Part D plan when you were eligible, you will likely pay a penalty when you do sign up. This doesn’t apply if you had credible drug coverage from other sources like group plans.

This is the next challenge as Part D prescription plans VARY WIDELY YEAR TO YEAR. What was the best choice for you last year may not be the best for you in 2020.

Medicare has created an easy-to-use, prescription drug plan Enter you zip code and then enter your drugs. The website saves your drug list with a Drug List ID number and a password so you can retrieve your list or make changes yearly. Selecting a pharmacy then shows you the cost of each prescription. The website shows you the least expensive and best coverages for your prescription medicines. They are listed from least expensive to most expensive out of the 52 drug coverage choices presented yearly.

The Region 10 SHIP office at (970) 249-2436 offers appointments for counseling. The Montrose Senior Center (Montrose Pavilion), (970) 901-9914, is offering informative presentations on Medicare Open Enrollment choices “Need Help” with personalized direction on October 21st at 1:00 P.M., and a look at understanding the New Medicare Changes for 2020 on November 18th at 1:00 P.M. These resources are very informative to your health and drug coverage discussions for the next year.

More information: the official U.S. government site for Medicare. Expand Resource Menu. Main Menu. “Welcome to Medicare” preventive visit (what to expect).

Pay It Forward Variety Show—Thank you from Marilynn

Thank you, Arigato, Gracias, Merci Beaucoup, Tadah, Spasibo and Obrigado. Thank you to all the volunteers at the Pavilion Senior Center who helped so whole-heartedly to create the Alive and Still Kickin’ variety show and BBQ. What an exciting show this was with a comedian, ventriloquist, Barbershop choir, Cabin Fever band, the famous keyboard style of Tim Veazey, Paul Chamberlain on guitar, along with the the exciting Omawari Mexican Folklore Dancers.

People at this community center are so full of talent and energy, they don’t see themselves as being “seniors” as they continue the legacy of the Golden Circle Seniors volunteers. Altrusa of Montrose is one our biggest supporters. This energetic organization is always looking for the best ways to contribute to our Montrose community. They really make a difference to our Senior Center and our town. We are ever so grateful.

There are many ways we can thank our sponsors—Gracias, Thank you, Merci Beaucoup, and much gratitude to the Montrose Daily Press, San Juan Publishing, Office Depot, Brookdale Senior Living Center, the Lions Club, and the American Legion, and all the people that donated to the “Pay It Forward” lunch fund.