Describing Medicare as something that can at times be confusing, Ohio Department of Insurance Public Information Officer Rebecca Hayward answered questions and gave guidance on Medicare, Medicare supplements and advantage plans recently at the Highland County Senior Citizens Center.
“One of the most asked questions we get is when can you enroll in Medicare,” she said. “The easiest thing to remember is what is called the seven-month initial enrollment period, which is three months before you turn 65, the month you turn 65 or three months after your 65th birthday.”
According to Medicare, the annual open enrollment period for 2020 coverage begins on Oct. 15 and continues until Dec. 7, 2019, with a general enrollment period for those didn’t sign up when first eligible between Jan. 1 and March 31 each year, with coverage starting on July 1 of that year.
She said that every person’s situation is unique, that Medicare isn’t a “cookie cutter” approach to health care, and that a person who is already retired but is covered by a spouses private health plan should evaluate which plan would be more cost effective — the private plan or Medicare.
Traditional Medicare came about in 1965, with Part A designed to cover hospital stays and Part B doctor visits, but Heyward said people can instead opt for the Medicare Advantage product, formerly called Medicare Plus Choice, which is sold by a private insurer that contracts with the federal government to provide Parts A and B, and also Part D, that covers prescription drugs and came into existence in 2006.
While she said most everyone understands that Medicare basically pays 80 percent and a Medicare supplement picks up the remaining 20 percent, her office still receives irate phone calls from patients regarding things they thought were covered, but were not.
Some of the items and services listed in the “Medicare 101” booklet that are not covered by Medicare include:
•Long-term care, also referred to as custodial care;
•Most dental care;
•Dentures;
•Eye examinations related to prescribing glasses;
•Cosmetic surgery;
•Acupuncture;
•Hearing aids and the exams for fitting them;
•Routine foot care;
•Most care outside of the U.S., including cruise ships.
She also emphasized the importance of keeping up to date on current Medicare and Medicare Advantage plans, especially when it comes to Part D prescription drug coverage.
“People need to know which insurance card in their wallet or purse is the one they need to be carrying,” she said. “They should always open the mail that pertains to the insurance they presently have, and be sure to check your Part D prescription coverage every year since both your needs and the insurance plans available will change.”
It’s important to pay attention when the mail pertaining to current coverage shows up, she said, adding to be aware of any increases in premiums and co-pays, and to do the same with any Medicare Advantage plans as well.
“Don’t just assume that the product you purchased is going to be exactly the same every year,” she said. “Not only can the costs change, but companies can add benefits and take benefits away, so if you bought a plan because it had a zero premium and had dental and vision benefits, but you haven’t looked at it in four years and now that coverage is gone.”
While not endorsing them, she said one advantage to having an Advantage plan has to do with maximum out-of-pocket protection, with Advantage plans capping out-of-pocket expenditures where traditional Medicare doesn’t.
She said traditional Medicare doesn’t have any maximum out-of-pocket protection and if a person had medical bills of $2 million in a calendar year, they could potentially be liable for 20 percent of those costs, or $400,000.
Highland County Senior Center Executive Director Mechel Frost said the programs offered in conjunction with the Ohio Senior Health Insurance Information Program are designed to help seniors sort through the maze of rules relating to Medicare, and to offer counseling and assistance.
“The next time the OSHIP program will be here will be Tuesday, July 16 for one-on-one counseling,” she said. “That way if they have specific questions that weren’t answered in the seminar that we just had, they can sit down with a counselor and go over their personal information.”
She said the senior center is currently accepting appointments for the July counseling session in addition to s Medicare update seminar on Sept. 27 that will address changes for next year.
Additional counseling sessions are set for later in the year on Oct. 15 and Nov. 19.
FRost said to schedule an appointment for either the counseling sessions or update seminar, call the Highland County Senior Center at 937-393-4745.
Reach Tim Colliver at 937-402-2571.
