Indiana State Health Insurance Assistance Program (SHIP)

(Woman:) I was overwhelmed with Medicare before I turned 65. There were so many decisions to make! I was confused. If you’re almost 65, now is the time to learn all about Medicare and your Medicare options. Medicare is a health insurance program for people age 65 and older, people under age 65 with certain disabilities, and those with end-stage renal disease. Eligibility for Medicare isnotbased on your income. Original Medicare has two parts: Parts A and B. Most people get Part A when they turn age 65. If you or your spouse paid Medicare taxes while working at least 40 quarters, no premium is paid to get Part A. If you’re not eligible for premium-free Part A, you may be able to buy it. Medicare Part A helps cover inpatient hospital or skilled nursing care. In most cases, you pay a deductible or copays, based on the length of your stay, and then Medicare picks up the rest. Medicare Part B is voluntary and you would likely pay a 10% penalty for each year that you aren’t enrolled should you need to enroll later. It requires a premium and helps cover doctors’ visits and other medical services such as lab work not covered by Part A. Part B pays 80% after an annual deductible. It will pay 100% of your preventive services at your doctor’s office. Your benefits include a “New to Medicare” exam and then an annual Wellness visit. (Woman:) I knew Medicare was guaranteed after I turned 65, but I got so much mail from insurance companies. I did my research and found a supplement that was right for me. Medigap and Medicare supplement insurance are the same thing. Your guarantee of a Medigap plan starts the month that your turn 65 and lasts for 6 months. There are 11 standardized Medigap plans designed by the federal government to fill the coverage gaps of original Medicare. This includes deductibles and copays, extended hospital stays, outpatient services, tests, and emergency care overseas. Medigap plans are sold by private insurance companies. Each company can charge different prices for the same plan, and the company chooses which Medigap plans to offer. You must have both Parts A and B of original Medicare to purchase a Medigap plan. Your Medigap plan is guaranteed renewable as long as you pay your premium. (Woman:) My friends have told me about Medicare Advantage plans. They say I can save a lot on premiums. So I looked and found one that I think will work for me, but I have to wait till the annual open enrollment on October the 15th to December the 7th to make the switch. Medicare Advantage plans are health plans you buy from private insurance companies. They replace Medicare Parts A and B rather than supplement them like a Medigap policy. Most Medicare Advantage plans will also include Part D drug coverage. You will still pay your Part B premium in addition to any premium charged by the insurance company. To enroll in a Medicare Advantage plan, you must be enrolled in original Medicare Parts A and B. You can change your Medicare Advantage plan every year between October 15th and December 7th. Your new coverage will start on January 1st. Medicare Advantage plans offer your Medicare benefits plus additional benefits through one plan. You must use providers contracted through a network of preferred providers. Some Medicare Advantage plans provide out of network benefits, but you may have to pay more. You will only have emergency services covered outside of services covered outside of the plan’s service area. the plan’s service area. (Woman:)Some of the drugs weren’t covered by my first Part D plan, and I paid a lot out of my own pocket when I hit the donut hole. When the next Open Enrollment comes around, I’m going to compare plans so I can get all my drugs covered. Prescription drug plans that work with your Medicare coverage are called Part D plans. They are purchased through private companies that contract with their own pharmacy network. Part D plans can be bought separately to go with Medigap policies or are included in most Medicare Advantage plans. Part D generally has 4 stages of coverage. One. The deductible which is paid first before coverage starts. Two. The initial coverage which includes co-pays based on the type of prescriptions you have. Three. The coverage gap (known as the donut hole) in which the plan no donut hole) in which the plan no longer pays for your longer pays for your prescriptions until you pay a certain amount out of pocket. And four. The catastrophic coverage which will pay for 95% of your drug costs. You will need to know that your list of drugs are covered by the plan’s formulary to determine which one best meets your needs and provides the lowest out-of-pocket expense. If you have other drug coverage from an employer or the VA that is equal to or better than the benefits provided by Part D, you can use that coverage instead. If you do not enroll in Part D or do not have other creditable coverage, you will pay a 1% penalty later for each month that you weren’t covered should you need to enroll in Part D later. (John:) Joe, when I retired from the federal government, I knew I needed to keep my federal health benefits to go along with my Medicare. (Joe:) I know John. The same was true with my TRICARE. If you retire with health benefits from an employer, you should always make sure you take full advantage of the employer’s benefits and understand how these benefits coordinate with your Medicare options. Often employers, including the federal government and the military, offer retiree health plans that coordinate with Medicare. Remember that as long as you are actively working or covered by your spouse who is actively working after age 65, you can use an employer’s health benefits. The employer’s benefits will be primary, and you can delay or suspend your Part B without penalty. Just make sure that you use your Special Enrollment Period to enroll in Part B when you or your spouse are no longer actively working. Enrollment in a Medicare Advantage plan will always be primary over any other coverage you may have. This means that in most cases you will not be able to use the other health benefits that you may have. You may also lose other coverage because you enrolled in a Medicare Advantage plan and won’t be able to re-enroll. (Woman:) I was really surprised that I would qualify for help paying for my prescriptions and my Part B premium. I was glad that I applied. A little extra money never hurt. There are two main programs that provide help paying your Medicare costs: Social Security provides extra help for paying for your Part D drug costs. If you qualify, the low-income subsidy (LIS) will cover your premium and co-pay in full or partially. You would not have a coverage gap or donut hole. The State’s Medicaid program also provides help through the Medicare Savings Program (MSP). This program could pay for your Medicare deductible, co-pays, and Part B premium or just your Part B premium. (Woman:)I really wish I had known about SHIP last year when I tried to help mom and dad find a health care plan with a lower premium. The State Health Insurance Assistance Program or SHIP is a program of the Indiana Department of Insurance. SHIP provides free, impartial health insurance counseling for people with Medicare. There are 300 trained counselors throughout the state who can meet with you for a face-to-face appointment or you can call SHIP’s helpline. If you have questions regarding Medicare, Medicare supplement insurance, Medicare Advantage, prescription coverage, or long term care, call us. 1-800-452-4800.

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