Seniors need to know health care options

The Clarion Herald asked Blue Cross Blue Shield of Louisiana what seniors should be aware of as they evaluate their health care options. John Maginnis, vice president of corporate communications, provided the following information:
What are the different parts of Medicare?
➤ Medicare Part A is hospital insurance, which helps cover inpatient hospital care, skilled nursing facility care, home health care and hospice care.

➤ Medicare Part B is medical insurance, which helps cover doctor visits, outpatient care, home health care, durable medical equipment and some preventive services.

➤ Medicare Part C is Medicare Advantage, which includes Parts A and B coverage, usually Part D coverage (prescription drugs) and extra benefits like vision and hearing. Medicare Advantage plans are offered through private insurance companies.

➤ Medicare Part D is prescription drug coverage, which helps cover prescription drug costs and is offered through private insurance companies.

What are the ages that people have to really be attuned to?

The eligibility period for people to apply for Medicare Part A and Part B begins three months prior to their 65th birthday and ends three months after the month they turn 65. This seven-month time span is called the Initial Enrollment Period.

How do people sign up for Medicare Parts A and B?

Most people are automatically enrolled for Part A once they apply for Social Security, which can be as early as three months before turning 65. Medicare Part A is free for most people. They can also apply for Part B any time during their Initial Enrollment Period, and they will pay a premium.

Some people don’t need to sign up for Medicare Part B if they are still working and have employer coverage (see related question below). What’s important to know is, if they do need to sign up for Part B when they’re first eligible and fail to do so, they may have to pay a late enrollment penalty to the federal government, which they’ll continue to pay as long as they have Part B.

What happens if people don’t enroll in Medicare during their eligibility period?

If a person is not enrolled in Medicare Parts A and B during their Initial Enrollment Period, they can sign up between Jan. 1 and March 31 each year. Their coverage won’t start until July 1 of that year, and they may have to pay a higher premium to the government for late enrollment.

If people are still working when they turn 65, do they still need to sign up for Medicare?

If a person is still working and is covered by their employer when they become Medicare eligible, they should check with their human resources department about how their employer insurance works with Medicare. If they work for a company with fewer than 20 employees, Medicare will be their primary insurer, so they should enroll in Medicare Part B during their Initial Enrollment Period. If they work for an employer with 20 or more employees, the employer’s coverage will be primary as long as they remain employed. In this case, they don’t need to enroll in Part B at age 65, but if they do, it will be considered secondary coverage.

What are the most important things people close to retirement age should ask about health insurance?

Budget, lifestyle and health are the top considerations for people nearing retirement age and deciding on their Medicare options. Some questions to consider:

➤ Do my doctors and other healthcare providers accept the type of coverage I am looking at?

➤ How much will I spend on premiums, deductibles and other costs?

➤ Is there a yearly limit on my out-of-pocket costs?

➤ Do I need a plan to cover prescription drugs?

➤ Will I be covered by this plan if I travel to another state or out of the country?

➤ How will this plan work with other coverage I have?

What are the options? 

Several health coverage options are available to people turning 65 or who are otherwise eligible for Medicare. One of the choices is Original Medicare (Parts A and B), which is managed by the federal government. Most people get Part A for free and pay a premium to the government for Part B. They generally pay a portion of the cost of each service covered by Original Medicare.

Medicare Advantage plans, also called MA plans or Part C, are offered by private insurance companies that include all of the services that Original Medicare covers, with a few exceptions like hospice care and clinical studies. These MA plans usually offer extra benefits, such as vision, hearing, dental, wellness and prescription drugs. Enrollees may pay a premium for their MA plan in addition to their Part B premiums.

Medicare Prescription Drug Coverage, also called Part D, is offered to everyone with Medicare through a Medicare-approved plan. There are two ways to get Part D coverage. The first is a stand-alone Medicare Prescription Drug Plan through a private insurer. This is typically purchased by people with Original Medicare or with a Medicare Supplement (Medigap) plan. The second way to get Part D coverage is through a Medicare Advantage plan that includes prescription drug benefits. It’s important to note that if people don’t sign up for prescription drug coverage during their Medicare eligibility period, they’ll likely pay a late enrollment penalty to the federal government if they join a plan later, and they’ll continue to pay that penalty for as long as they have prescription drug coverage.

Medicare Supplement plans, also called Medigap, are offered by private health insurance companies for a separate premium. They help pay some of the healthcare costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles. Medigap plans offer additional coverage like medical care when you travel outside the United States. Typically for these plans, Medicare pays its share of the cost and the Medigap plan pays the rest. Medigap plans do not offer prescription drug coverage (Part D).

People cannot be enrolled in both a Medigap plan and a Medicare Advantage plan.
It’s important to note that most people must have Medicare Parts A and B to enroll in Medicare Advantage, Medicare Prescription Drug Plans and Medigap plans.

What are important dates to remember?

In most cases, the only chance each year to make a change to Medicare coverage is during the Annual Election Period, also called Open Enrollment, which is from Oct. 15 to Dec. 7 each year. Coverage begins on Jan. 1 of each year.

How soon should people begin their planning?

Medicare options can be confusing, so it makes sense for people to get an early start when checking out plans. If they are new to Medicare, eligibility begins three months prior to their 65th birthday. Before then, they can start comparing plan types to find the one that best fits their needs. A good resource for this is, the official U.S. government site for Medicare. An agent or broker with Medicare training is also an excellent resource.

What Medicare options does Blue Cross offer?

Blue Cross and Blue Shield of Louisiana offers a series of Medicare supplement (Medigap) plans, as well as Medicare Advantage (Part C) plans through its subsidiary, HMO Louisiana, Inc. 

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