Andrea Thomas, patient health benefits manager with SEARHC, gave a presentation at the Irene Ingle Public Library last Thursday on the basics of Medicare. As many people know, Medicare is a government-run health insurance program. There is a common misconception that Medicare is reserved only for people 65-years-old and older. Thomas said in her presentation that this is not true. In fact, anyone under the age of 65-years-old with certain disabilities, end-stage renal disease, or Lou Gehrig's disease also qualify for Medicare. The purpose of her presentation, she said, was to help people better understand the basics of Medicare, what options are available, and how to go about signing up for it.
"These are really crucial decisions that actually last for the rest of your life," Thomas said.
In general, Thomas said, there are three parts to Medicare: Part A, hospital insurance, Part B, medical insurance, and Part D, prescription drug coverage. There is a Part C, "Medicare Advantage Plans," but Thomas said this is not available in Alaska. Instead, Alaskans can receive Medicare supplements.
Hospital insurance with Medicare helps cover things like, as the name suggests, hospital care. It also helps to pay for skilled nursing facility care, home health care, and hospice care. Medical insurance, Part B, covers doctor's visits, outpatient services, lab tests, medical equipment, and preventative services. Most people receive Part A free of premiums, Thomas said, if the person signing up or their spouse has paid FICA taxes for at least 10 years. Part A also completely covers the first 60 days a person is hospitalized. After 60 days, the cost begins to increase. After 90 days of hospitalization, those insured under Medicare begin to use their "Lifetime Reserve Days," which Thomas explained is a 60-day, lifetime allotment of extra days Medicare will help cover.
Part B has a monthly premium of $135.50, if the person is not receiving Social Security, or about $130 if they are. For the year 2019, there is also a $185 deductible. Under Part B, patients are expected to cover about 20 percent of their medical costs while Medicare will handle the other 80 percent.
Part D of Medicare helps to cover prescription drugs. This part of Medicare is completely optional, Thomas said. Medicare has a list of drugs that they will help cover the cost of. While patients are still expected to pay a monthly premium as well as deductibles and copayments, there is also extra help available to assist those on a limited income. Another perk of Part D plans, she added, is that people can re-enroll and change plans annually, to find a plan that meets their needs better.
"There's about 22 plans in Alaska, and they have different formulas and different drugs that they cover," Thomas said. "That's why it's good to check out what's the best combination for you."
Lastly, Alaskans considering Medicare should think about Medicare supplements. These are insurance policies, sold by private companies, to help patients cover deductibles and copayments. Thomas said that the supplements are designed to help fill any gaps left by Medicare. There are a wide variety of different supplement plans, she said, that vary in costs and coverage to meet patient needs.
Enrollment in Medicare is automatic for those who are receiving Social Security benefits or Railroad Retirement Board benefits, she said, when someone turns 65-years-old. For those who have not received any Social Security or Railroad benefits, though, Thomas said that they have to proactively sign themselves up for Medicare. For people not automatically enrolled, Thomas said there is an important seven-month window they need to be aware of, around their 65th birthday. Beginning three months before somebody turns 65-years-old, people can get themselves enrolled in Medicare without any problems. However, for each month after turning 65-years-old, there will be penalties for enrolling late. These penalties include higher premiums and having to wait longer for one's medical coverage to begin. There is also a general enrollment period, from Jan. 1 to March 31 of each year, for anyone who did not enroll during the seven-month initial enrollment period.
"You want to take care of it three months before you turn 65, because then it [Medicare coverage] will start that month you turn 65," Thomas said. "Now if you do it a month after, it's going to start one month after. If you do two months, it's going to start two months after ... After the seventh month, then you're at the point of each month that you don't have it, then you get penalized for not having Medicare."
To learn more about what options are available with Medicare, or to receive assistance with enrolling, Thomas provided a variety of resources. These include the Medicare and Social Security websites, as well as Alaska's state-specific Medicare information office, which can be found at http://www.medicare.alaska.gov. Thomas added that SEARHC is a good avenue for assistance. She said to call Patient Health Benefits Specialist Susan Briles at (907) 966-8662.
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