ElderCare Questions & Answers
Questions & Answers
November & December 2012
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November 20, 2012 – Eldercare Q&A
Medicare Open Enrollment Tips
Q: Any tips for Medicare Drug Plan Open Enrollment?
A: The Medicare Drug plan ‘open enrollment’ began October 15th, and ends on December 7th. Here are some tips about choosing a drug plan:
1.What should I look for in a plan? Most people pick a plan based on what drugs they use, what pharmacy they want to use, how much the plan costs, and whether they want a plan that covers just drugs only (a Medicare Prescription Drug Plan) or a Medicare Advantage Prescription Drug plan, which covers medical benefits AND prescription drugs.
2.Am I eligible for Medicare Drug Coverage? If you’re eligible for Medicare Part A or Part B, you are eligible for the Part D drug benefit. You can’t be denied because of a pre-existing condition. You can start a Medicare drug plan during the three months before your birthday, and up to three months after your birthday. If you are eligible for Medicare Part D, but don’t join, you may have to pay a penalty for joining late. If you have other drug coverage now, you may avoid the penalty.
If you’re turning 65 and are eligible for Medicare and Medicaid, you will be signed up for a prescription drug plan automatically. Medicare will pick a plan for you--but you may want to choose your own plan. If you are in a Medicare Advantage Plan, call the plan to see if you can add Medicare Drug Coverage. If you are part of an employer or union drug plan, ask if your coverage will continue, or if they think you should join a Medicare drug plan. If you have a “medigap” or Medicare supplemental insurance plan, you may still need to join a Medicare drug plan, because many medigap plans don’t cover drugs.
3.What will the Medicare Prescription Drug Coverage cost me? You will have to pay a monthly premium, a yearly deductible (if any), and a copayment for each prescription. If you make less than $17,044 ($22,944) for a couple), you should apply for “Extra Help” to lower your premiums, deductibles and copays.
Your overall annual cost includes your premiums, deductibles, and copayments for each prescription, and any drug costs you pay during the coverage gap, known as the”donut hole.” If your total drug costs (what you AND your plan pay for covered drugs) are greater than $2,970 in 2013, you will probably hit the donut hole.
Once in the donut hole, you will pay a discounted percentage of your brand or generic drug costs. If out-of-pocket costs reach $4,750, or your total drug costs hit $6,733.75, you reach the catastrophic benefit period, and your plan will pay for most of your drug costs.
4.Which drugs will my plan cover? Each Medicare Drug Plan has a “formulary,” a list of brand and generic drugs it covers, how much you will pay for each drug, and if there are any limits on getting a drug. Pick a plan that has all or most of your drugs on the formulary.
5. How do I find the right plan? In Massachusetts, you can get free help selecting the best Medicare Drug plan from a SHINE counselor. Just call 1-800-AGE INFO, and press “3.” You can also call Medicare. 1-800-MEDICARE 24 hours a day, seven days a week.
Turning 65 & Medicare
Q: Should I sign up for Medicare when I turn 65?
A: Yes, most people at 65 should take Medicare. Over the next 10 years, a total of 10,000 people every day will enroll in Medicare. Most people are eligible to get Medicare when they turn 65. Some people who are younger (ages 18 to 65) and have certain disabilities that prevent them from working can also get Medicare. To get Medicare Parts A and B you must be a United States citizen or have been living in the U.S. legally for at least five years nonstop.
Although many people think of Medicare as retirement health insurance, there are many people on Medicare who are past 65 and still working. People turning 65 this year must wait until they are 66 years old to collect full Social Security retirement benefits. But people turning 65 can get on Medicare---whether they continue to work or not.
If you’re 65 and still working (or your spouse is still working), and you work for a company with 20 full-time workers AND you get health insurance from them, you may not need all of Medicare. Most people should enroll in Medicare Part A, which pays for hospital bills, because it is free. Part A becomes the “secondary payer after your job's insurance. By taking Medicare Part A when you first become eligible, you will not need to worry about enrolling later. If you have a Health Savings Account (HSA) where you work, you may not want Medicare Part A right away, because your employer may stop contributing to your HSA account once you enroll in Part A. If you work for a company with fewer than 20 employees) or are self-employed, you will probably want Medicare Parts A and B (which covers doctors’ care) when you turn 65.
To apply for Medicare, contact Social Security at 1-800-772-1213, or visit them on the internet at http://www.ssa.gov/. Once you enroll, you will be sent your Medicare card, plus a "Welcome to Medicare" kit in the mail. If you choose to delay Medicare Part B now, you’ll have to contact Social Security later, either in person or by phone, to enroll in Part B.
Once you are enrolled in Medicare, you can also visit their secure website, where you can review and track your benefits. Through this free, online service, you can get 24/7 access to information about your Medicare benefits, print your recent Medicare claims and notices, track your prescriptions, and get direct assistance online from Medicare.
If you have you stopped working before age 65, you can’t get Medicare until you turn 65---unless you are disabled and have been getting Social Security disability benefits for two years. As you approach 3 months before your 65th birthday, you need to know that there are certain times when you can sign up for Medicare. If you delay signing up, you may have to pay higher monthly premiums when you do join.
If you are already getting Social Security benefits, like early retiree or disability benefits, when you turn 65, you will be automatically enrolled in Medicare Part A and Part B.