Medicare workshop helps future enrollees navigate the process

To welcome you to the next stage of life, here’s a thick book about Medicare. One look at it is enough to cause anyone to respond with a blank stare.

In an effort to help citizens facing the uncertainties of Medicare and help them better understand this comprehensive health care program, Blue Mountain Health System has been offering “New to Medicare” programs at the Gnaden Campus in the Community Room.

Donna Shelly, a case aide with the Carbon County Area Agency on Aging, has been on hand with information and a PowerPoint presentation. Her goal is to provide “an overall view of Medicare including hospital care, physician and lab work and prescription drug coverage.”

During a recent presentation, Shelly went over Medicare Parts A, B and C, and Medicare supplemental insurance including Medi-Gap policies, Medicare Advantage plans and Medicare Prescription Drug Plans (Part D).

People get overwhelmed by the thickness of the book about Medicare, and tend to look elsewhere for answers, but it really is a good source of information, she said.

“Look at the book, the thick book about Medicare. I know it’s a lot,” Shelly said. “A lot of people tell me, ‘I didn’t know that.’ It’s in the book. That book has a lot of information.”

Shelly went over some of the basics of Medicare, such as who is eligible and when.

Medicare is health insurance for people 65 and older, those under 65 with a disability, or those at any age with end-stage renal disease.

Enrollment occurs automatically once a person begins receiving Social Security or Railroad Retirement Board benefits, but the initial enrollment period begins three months before a person turns 65 years old or after 25 months of receiving monthly disability benefits. But if a person is still actively working, then enrollment is not automatic.

People who are eligible and actively working, but want to receive Medicare need to contact the Social Security office to enroll.

They can go to the local office, call 800-772-1213 or go online to www.socailsecurity.gov. Those retired from the railroad need to call their local RRB office at 877-772-5772.

Shelly said the initial enrollment period lasts seven months: three before the 65th birthday, the month of the birthday, and the three months after the birthday. During this time, there are no health questions asked.

“After you’re outside your initial enrollment period, they will take into account your medical history,” she said.

There are four parts of Medicare. Part A covers hospital insurance and is free for most people. Part B covers medical insurance. Part C includes Medical Advantage Plans that work like a PPO or HMO. This is not free.

These plans include Parts A and B and sometimes Part D, which is Prescription Drug coverage. Medical Advantage Plans will take into account a person’s medical history.

Shelly said that some people will take Part A, but opt out of Part B. The problem is they will have to pay a premium for Part B if they decide they want it later after they have already been receiving Medicare benefits.

People who decide to go with original Medicare and get Part A and B have the option to also pay for a Medigap Policy (supplemental insurance) to cover costs not paid by A or B, for example copays. There is also a $183 deductible for Part B annually.

“The time to get a Medigap plan is during your seven months (the initial enrollment period),” Shelly said.

If a person chooses Part C (similar to an HMO or PPO), they cannot also apply for Medigap, because the Medicare Advantage Plan most likely already covers those costs.

Shelly told those attending that if they choose to get a Medigap policy or Medicare Advantage Plan, they shouldn’t just get what a friend or family member recommends, because each person has different health needs. She recommends making an appointment and meeting with a case aide to weed through the options.

Some tips she provided about Medicare and Medigap include:

• Plan G is the same coverage no matter which insurance company provides it.

• Plan F will not be adding any more people, but people in the plan cannot switch to another one.

• The Medicare card is not an actual card. It is a marked out corner on a page of information sent to a person.

• Once a person receives Medicare, he or she cannot receive a marketplace medical insurance.

Joe Seemiller of Lehighton said he attended the presentation to get some answers.

It was “very helpful,” Seemiller said. “I knew it was complicated, but this is absurdly complicated.”