Medicare, how to save it and which plan is best, was a hot button topic in the election until overshadowed by the financial crisis.
Whatever changes may come with the shift in power, people still need to make Medicare decisions as they reach retirement age, and once a year they have a window to change some of those decisions. Nov. 15 - Dec. 31 is one such time, the annual election period.
Thom Hughes, an insurance agent specializing in Medicare plans, discussed what options are currently available for seniors. Hughes, of the Texas Financial Center, has been dealing with seniors over 65 and those under 65 with disabilities for years and keeps up with issues affecting those groups. He cautions against companies that use hard sell tactics, and whose benefits may not be appropriate for people living in rural areas like Jasper.
"The best option for the Medicare beneficiary is very specific to them as an individual," Hughes said last week. "The agent must account for where the beneficiary lives, their income, their health condition and how much coverage is appropriate."
Seniors reaching 65 face a bewildering range of options, and can be tempted by plans that seem economical but won't serve their needs. Some plans have benefits so low they are almost not worth having, according to Hughes.
Plans can vary by zip code, not so much that companies discriminate against rural areas, but in terms of the services available being different than those in an urban area. A Jasper zip code is a good place for a Medicare Advantage plan, according to Hughes.
Using a mild heart attack as an example, Hughes said a typical emergency treatment for a 60-year-old woman on Medicare disability could run $60,000. Basic Medicare would pay 80/20; that is, they would pay 80 percent after the deductible, but the patient would be responsible for about $12,000. With a zero-premium Medicare Advantage plan, her out of pocket expense typically might be under $1,500, sent as a "balance bill" after services are rendered.
People have a narrow window to make decisions on their Medicare plan. It's not that they can't change Medicare supplements later, but it is only as they enter Medicare eligibility that they cannot be turned down for a plan because of a pre-existing condition.
"These Medicare Advantage plans are not my number one choice for people over 65," Hughes said, "but some people cannot afford the monthly premium for a Medicare supplement."
Some plans can cost as much as 2/3 of a person's social security check each month.
Private Fee for Service, PFFS, works very well here, according to Hughes, but by 2010, the cuts proposed by Congress could affect all these plans. For the time being, someone in good health turning 65 is best served with a Medicare supplement and a Part D plan for prescription drugs. Hughes said don't wait to sign up for part D; for each month you delay, it will cost a one percent cent penalty, permanently, under the current rules.
For someone in reasonably good health but without much in the way of financial resources, going on a Medicare Advantage plan is better than going without, according to Hughes.
"No premium, zero, is precisely what many people can afford," Hughes said.
It's important to note that Medicare or Medicaid-and ultimately the taxpayers-still pick up the tab. A Medicare Advantage plan shifts some of the administrative burdens to private insurers, who often offer additional support such as wellness programs and 24/7 hotlines to help reduce healthcare expenses.
There's a lot of reasons people who are poor still can't qualify for Medicaid, Hughes said. Owning a second piece of property, even a partial interest split among siblings, may disqualify someone from getting Medicaid.
Hughes said you have to be careful about signing up for a Health Maintenance Organization (HMO), which may provide good service in a city but historically hasn't worked well in rural areas. In addition, if you are using a home health service, signing up for an HMO may mean having to give up home care service or change to another provider, which is not the case with PFFS.
Seniors with friends and families in urban areas may be surprised to hear that, but Hughes thinks it's important that people understand what works in one situation doesn't work for all.
"The view towards HMO's is very different in cities like Houston," Hughes said. "They don't have the problems we do here."
Private Fee-for-Service plans (PFFS) works differently than a Medicare supplement plan. The doctor or hospital you choose must agree to the plan's terms and conditions prior to providing service, with the exception of emergencies.
As long as that condition is met, some plans will provide zero co-pay for office visits and laboratory services, and may offer small co-pays for routine vision, hearing and dental checkups. Out-of-pocket maximums may vary. Drugs are generally not covered and would still require that the client select a Part D plan.
These days, many people turn to the internet for information, and even seniors who may not be savvy to electronic information have children and grandchildren willing to help.
Resources like AARP (www.aarp.org) have a wealth of information, but be aware that it is generic and not specific to your area. Also know that they are in the business of selling and promoting their own insurance programs.
Before signing up for any program, check with your doctor and any other health care providers you use to be sure you will be able to continue with them, or if you must change, be sure that you will be satisfied with the new arrangements.
You can also check with the Better Business Bureau of Southeast Texas, www.bbbsetexas.org, to see if the plan you are considering has a history of complaints against it.