It’s that time of year again – when many people reevaluate their health care needs and decide whether it’s time to change health plans, especially for individuals 65 and older, as open enrollment for Medicare ends on Dec. 7.
What is Medicare?
Medicare is health insurance for people 65 or older, and a person becomes first eligible to sign up for Medicare three months before turning 65. According to Medicare.gov, a person can qualify for Medicare earlier if they are diagnosed with a disability, end-stage renal disease or Lou Gehrig’s Disease (ALS).
Medicare includes a range of coverage: Part A, hospital insurance, helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and home health care; Part B, medical insurance, helps cover services from doctors and other health care providers, outpatient care, home health care, preventive services such as screenings, shots or vaccines, and durable medical equipment such as wheelchairs and other equipment; Part C, known as Medicare Advantage; Part D, drug coverage, helps cover the cost of prescription drugs.
Medicare Supplemental Insurance, or Medigap, is extra insurance a person can purchase from a private company. Medigap helps pay your share of costs in Original Medicare.
Original Medicare v. Medicare Advantage
Original Medicare includes Part A and Part B, and a person can purchase a separate Medicare drug plan to obtain Part D. Individuals can seek medical services from any doctor or hospital that takes Medicare anywhere in the U.S.
Medigap helps pay out-of-pocket costs such as the 20% coinsurance in Part B for each Medicare-covered service. A person must purchase an extra policy, Part D, for prescription drugs, and it would help lower the cost for services in Part A and Part B. A former employer, union or Medicaid may cover this portion.
Medicaid is a federal program providing health coverage for some people with limited income and resources.
Part C, Medicare Advantage, is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health and drug coverage. These plans bundle Part A, Part B and usually Part D.
In most cases, individuals who choose Part C do not qualify for medical services from doctors outside their network. Part C plans may also have lower out-of-pocket costs than Original Medicare.
There are differences between Original Medicare and Medicare Advantage such as doctor and hospital choice, cost, coverage and foreign travel.
Health plans are unique
Aston Dng, an assistant at First Source Tax & Insurance Services in Westminster, said choosing the right Medicare plan can be complicated because many options and factors affect someone’s decision.
He is the first person clients meet before speaking with a supervisor, who then helps them into a health plan.
“My job is to narrow down what the best plans or benefits are for each individual coming to us,” Dng said. “They (clients) need time to digest a lot of information and compare it to their previous health plan.”
Cynthia Viveros, a certified agent employed at JAR Insurance Services, helps clients throughout California enroll in a health plan that is best for their needs.
Viveros often assists seniors and other clients in the Santa Clarita Valley at the Samuel Dixon Family Health Center.
“I give back to the community by providing a ton of educational information, and most importantly, I care,” Viveros said. “They (clients) know it because they are put on (a health plan) that is the most appropriate for them.”
Tips and advice for choosing a health plan
First and foremost, Viveros encourages everyone 65 and older, especially those about to turn 65, to call the U.S. Department of Social Security Administration at 1-800-772-1213 to see if they’re eligible for Part A or Part B, or to be told how many months’ worth of work they need before qualifying for benefits.
“I think a big responsibility is given to our seniors in that they’re going to be able to read and navigate the system when in reality it is very complex,” Viveros said.
Another piece of advice she has is for individuals to know their primary care physician because whichever plan they decide on, it could be that their primary physician is not under that health plan.
“They (clients) pick a doctor and then we assign it,” Viveros said. “They can always change the first of the following month because it’s such a personal relationship that you establish with the doctor.”
The third tip she offers is to plan, ask big questions and seek out assistance if necessary.
Individuals should plan and enroll in a plan as soon as possible, as that would prevent an added cost each year selecting a health plan within a time frame, she added.
Although there is still much to cover, her last bit of advice is to be careful when approached by agencies. Some agencies might enroll a client into a health plan that doesn’t meet their needs and may harm them in the future, she said.
“It’s a lot of information that is needed and the sooner the community gets it the better they are,” Viveros said. “They may not need it right now, but it’s instilled in their mind that it’s something that’s going to come.”