Medicare: Can Advantage be a disadvantage?
Staff writer
No 65th birthday goes unheralded in America — at least not for those eligible for Medicare.
As the milestone approaches, mailboxes of soon-to-be Medicare recipients begin to fill with a bewildering barrage of ads and flyers.
The phone starts to ring, and somewhere amid the marketing onslaught, people turning 65 have important decisions to make.
Traditional Medicare or Medicare Advantage? What about prescription drug coverage? Will Medicare pay the entire bill? Are dental, vision, and hearing covered? And most important: Will the plan cover the doctors, hospitals, and pharmacies you use?
“It is good to start early to do your fact-finding and asking questions because there are so many things that you want to be considering when you’re getting ready to turn 65,” said Rodney Denholm, family resource management agent with Chisholm Trail Extension District.
Denholm will present a free Medicare Basics class from 5:30 to 7 p.m. Tuesday at the extension office at 1116 E. Main St. in Marion. Reservations are encouraged but not required.
The class is one of two impartial resources available to Marion County residents trying to navigate Medicare.
Residents also can receive free one-on-one assistance from Senior Health Insurance Counseling for Kansas through the Marion County Department on Aging.
Unlike insurance agents selling policies, the trained counselors aren’t paid commissions based on plans people choose.
“Our mission is to help educate the community,” Denholm said. “Our job is just to help people know, ‘Here’s the information that’s available,’ and we want you to make the best, most informed decision.”
For most people, Medicare eligibility begins at 65, but planning should start before then.
Initial enrollment generally extends for seven months — beginning three months before the month in which a person turns 65 and continuing for three months afterward.
Waiting can cause problems, particularly for someone whose existing health insurance is ending.
“You could have a gap in coverage,” Denholm said. “So it’s good to plan ahead.”
Late enrollment can result in penalties for some Medicare coverage, including Part B and Part D. Those penalties may continue for years or even for as long as the person has the coverage. (There are exceptions, including for people who continue to have qualifying coverage through their employment.)
The class next week will explain the Medicare alphabet: Part A, which primarily covers hospital care; Part B, which covers physician services and other outpatient medical care; and Part D, which provides prescription drug coverage.
Then there is Part C, better known as Medicare Advantage. Those plans are offered by private insurance companies approved by Medicare and generally bundle Part A and Part B coverage, often with Part D and additional benefits.
Traditional Medicare generally pays about 80% of the Medicare-approved amount for covered Part B services after the patient pays a deductible, Denholm said.
Many enrollees purchase a Medicare supplement, or Medigap coverage, to help with expenses Medicare does not pay.
Traditional Medicare generally does not cover routine dental, vision, or hearing care, so those wanting that coverage may need to consider additional options.
Medicare Advantage plans can be attractive because some offer extras not included in traditional Medicare, such as gym memberships and other benefits. But Denholm cautions that consumers need to look beyond the perks.
“If you sign up for a Medicare Advantage plan, you’re working with a private insurance company and not directly with Medicare,” he said.
That means there may be limits on which providers are covered under the plan.
A plan might offer “a gym membership or grocery cards,” Denholm said, “and those all sound great. But I also need to know: Is my doctor on the list? Is my pharmacist on the list? Is the hospital in my area on the list?”
Those questions can be particularly important in this area, said Lu Turk, director of the Marion County Department on Aging, which coordinates SHICK in Marion County.
“We live in rural America,” she said. “Transportation is our biggest challenge for seniors.”
With some Medicare Advantage plans, she said, staying in network could mean traveling to Wichita or another community for care that’s covered in-network. That may be difficult for older residents who no longer drive, particularly in an area with limited public transportation.
The goal, Denholm said, is not to steer people toward one type of coverage but to make sure they understand what they are buying — and “what questions should we be asking before we say yes.”
The decisions don’t end once someone has Medicare.
For those already enrolled, Medicare’s annual open enrollment period, Oct. 15 through Dec. 7, provides an opportunity to review coverage for the coming year.
Denholm particularly encourages residents to review their Part D prescription drug plan annually. Plans can change their premiums, costs, and lists of covered medication from year to year. A plan that worked well this year may not be the best choice next year.
SHICK counselors can help residents compare plans based on individual prescriptions. For a one-on-one review, residents may bring a complete list of their medications including dosages. That kind of individualized, impartial assistance can be valuable when consumers are being bombarded with Medicare advertising.
Denholm noted that aside from official Medicare materials, calls and solicitations arriving around Medicare enrollment generally come from businesses interested in selling a product or service. The class next week has nothing to sell.
“This is a free class. It’s impartial,” Denholm said. “We’re just wanting to get the information out so everyone can make the best decision for themselves.”
For those facing Medicare choices, that may be the best place to start: not with a sales pitch, but with the right questions.
More information is available from Denholm at (785) 263-2001 or Turk at (620) at 382-3580.