Medicare is something we Americans eagerly anticipate most of our lives.
Imagine! All of our medical bills paid for with no muss or fuss.
Until you start to apply. It’s a fairly complex system, and it’s
daunting—even for the most system-savvy person (sure, you aced the
FAFSA forms, but this is entirely different). It pays to educate yourself,
both before applying for the first time as you approach age 65 and also
as the Annual Enrollment Period (AEP) looms,
December 7—that’s when you can make changes to your existing plan.
A Word About Costs
No one is being cagey if they say, “It all depends,” when asked
what Medicare costs. It really does depend. “The ‘standard’
premium for Medicare Part B—basic medical coverage—runs about
$134 a month,” Straub says. “A Medicare Advantage HMO in Los
Angeles County has no additional premium. A top-of-the-line Medigap plan,
which allows you to choose your own doctors, might run from $175 and up
to $300. Premiums depend upon a person’s age, and increase over
time. If you need a Part D prescription plan, that will add an estimated
$25 per month.”
She adds, “With your red, white and blue [Original Medicare] card,
80% of your costs are covered. But there’s no cap to that, and you
also have deductibles. Medigap will cover that gap or a portion of it.”
Medicare Advantage HMOs that contract with medical groups such as Torrance Memorial IPA
or HealthCare Partners have no additional premiums in Los Angeles County.
“Kind of the deal of the century,” says Straub. “There
are no co-pays for hospitals or doctors, and you have unlimited days for
necessary hospital stays. The main caveat is that you agree to work with
a network of doctors that the HMO insurance plan is contracted with.”
In the case of nonprofit Torrance Memorial IPA, that includes more than 450 of the South
Bay’s best doctors—and it’s constantly expanding. To
use an IPA or medical group such as THIPA, you first sign up for an HMO
insurance plan, then opt in with the IPA.
If You Already Have Medicare
You still might be getting all those flyers, and that’s because the
Annual Enrollment Period (AEP) is when the insurance companies providing
Medicare Advantage Plans make changes. The biggest changes for 2018, says
Vince Kelly*, a health insurance consultant who specializes in Medicare,
“can be the prescription drug costs. That’s what you really
want to watch for when thinking about changing plans or when you get your
EOC (Evidence of Coverage) or ANOC (Annual Notification of Coverage) notice.”
This is particularly true if a person is taking brand name prescription
drugs, because generics are usually covered with a small co-pay.
Insurance companies categorize prescription drugs into “tiers,”
and the higher the tier, the more co-pay for that medication. “For
instance,” explains Kelly, “if you are taking a premium tier
drug, such as Januvia® or Advair®, you want to check to make sure
you can still get it covered. And it might pay to look around and see
if it’s considered a lower tier with another insurance company.
You have to be careful because the drug coverage changes all the time.
If you are getting prescriptions by mail order, make sure that will continue
as a benefit.”
The second-biggest change will be what other benefits are included or not,
such as discounted gym memberships, behavioral health and dental care,
and which durable goods will remain in your plan.
Questions about Medicare? Contact your health insurance agent. If you do
not have one, call 310-257-7239 for a no cost, no obligation consultation
or visit medicare.gov.
*Rose Straub and Vince Kelly are independent licensed agents and not employed
by Torrance Memorial Medical Center.