Seniors review their options at Medicare workshop in Modesto [The Modesto Bee]

Oct. 18--MODESTO -- About 200 seniors attending a workshop Thursday in Modesto reviewed the costs and benefits of the Medicare Advantage plans available in Stanislaus County.

This fall, Humana became the eighth insurer to offer Medicare managed-care plans in the county for people age 65 and older. It rolled out a basic plan with no monthly premium and a $42-a-month plan covering medical services, prescription drugs in Medicare's coverage gap and routine dental.

Other government-approved managed-care plans are offered by Easy Choice, CareMore, Care 1st, Citizens Choice, AARP-Secure Horizons, Kaiser Senior Advantage and Health Net.

With basic Medicare, patients can face huge bills for extended hospital stays and are responsible for 20percent of routine medical expenses. The federal government works with insurers to provide Medicare Advantage plans providing additional coverage. Medicare supplements are another way to cover deductibles and co-payments.

The monthly costs for managed-care plans or supplemental insurance are on top of the Medicare Part B premium that's deducted from seniors' Social Security checks. As of Thursday, the federal government had not announced the monthly Part B premium for 2014. It was $104.90 this year.

An enrollment period, starting this week and running until Dec. 7, allows people to sign up for Medicare or make changes to coverage that will take effect Jan. 1.

Every year, the Health Insurance Counseling and Advocacy Program in Modesto holds workshops to explain the enrollment process and options for seniors. Two more workshops are set for Thursday from 9 to 11 a.m. at the Turlock Senior Center, 1191 Cahill Ave., and Oct. 29 from 1 to 3 p.m. at the Gladys Lemmons Center in Oakdale, 450 E. A St.

Sandy Ranzo-Howell, a counselor for HICAP, advised seniors who are thinking about changing coverage for next year to ask themselves key questions: Can I still see my doctor? Will the health plan cover my medication? What hospitals can I use?

She reminded seniors older than 65 that they're not affected by the Affordable Care Act and not eligible for the subsidized health plans sold through the Covered California health exchange. The federal health law will close the "doughnut hole," or coverage gap, in Medicare's prescription drug program by 2020.

Next year, coverage will stop when a patient's retail costs for drugs total $2,850 for the year and will resume when costs hit $4,550. Inside the gap, the patient will be responsible for 47.5 percent of costs for brand-name drugs and 72 percent for generics.

Here is an outline of the Medicare Advantage plans in Stanislaus County:

-- Easy Choice: the zero-premium Best Plan introduced last year is replaced by a new version in 2014, so subscribers need to re-enroll. Benefits include no co-payments for hospital stays, physician visits, outpatient surgery, lab tests or X-rays, coverage for generic drugs in the doughnut hole, and routine dental. Annual out-of-pocket limit is $6,700.

-- AARP Medicare Secure Horizons: Plan 1, $89 a month; co-pays are $200 per hospital stay, $10 for physician visits, zero for outpatient surgery, $250 for emergency ambulance, 20 percent for medical equipment and lab work, $13 to $15 for X-rays, $4 to $8 for generic drugs, $45 to $95 for brand drugs. No drug coverage in gap. $35 per month for dental. $4,900 out-of-pocket limit. Plan 2, no monthly cost; higher co-pays.

-- Care 1st: zero monthly cost; no co-pays for hospital, primary care, X-rays and lab; co-pays are $5 for specialists, $20 to $50 for outpatient surgery and services, $125 for ambulance, 20 percent for medical equipment, zero to $5 for generic drugs, $30 to $50 for brand drugs. Generic drug coverage in gap. Dental included. $3,400 out-of-pocket limit.

-- CareMore: Value Plus, $49 a month; co-pays are $100 per day for hospital (up to five days), $20 for specialists, $100 for outpatient surgery, $195 for ambulance, zero to $249 or 20 percent for medical equipment, zero for tests, zero to $5 for generic drugs, $35 to $85 for brand drugs. Gap coverage for generic and some specialty drugs. $9 per month for dental. $3,400 out-of-pocket limit. Start Plus, no monthly cost; higher co-pays.

-- Citizens Choice: No monthly cost; no co-pays for physician visits, 45 days in hospital or tests; co-pays are $100 for ambulance, zero to $350 or 20 percent for medical equipment, $5 to $30 for generic drugs, $75 or 33 percent for brand drugs. No drug coverage in gap. Dental included. $3,400 out-of-pocket limit.

-- Health Net: Healthy Heart, $169 a month; co-pays are $150 per day for hospital (up to four days), $10 for primary care, $20 for specialists, $150 for outpatient surgery, $225 for ambulance, 20 percent for medical equipment, zero for tests, $3 to $12 for generic drugs, $45 to $95 for brand. No drug coverage in gap. $19 to $29 per month for dental. $3,400 out-of-pocket limit.

-- Humana: No monthly cost; no co-pays for primary care and first two days in hospital; co-pays are $5 for specialists, $325 for three to seven days in hospital, zero to $200 for outpatient surgery and services, $65 for ambulance, 20 percent for medical equipment, zero to $15 for tests, $3 to $10 for generic drugs, $45 to $95 for brand drugs. No drug coverage in gap. $6,700 out-of-pocket limit. Second plan, $42 a month; different co-pays, with drug coverage in gap. Dental included. $3,400 out-of-pocket limit.

-- Kaiser Senior Advantage: Enhanced, $75 a month; co-pays are $175 per day for hospital (up to seven days), $15 for primary care and specialists, $150 for outpatient surgery, $200 for ambulance, 20 percent for medical equipment, $40 for tests, $5 to $15 for generic drugs, $45 to $95 for brand drugs. Generic drug coverage in gap. $20 per month for dental. $3,400 out-of-pocket limit. Basic, $10 a month; higher co-pays; generic drug coverage in gap. $5,900 out-of-pocket limit.

For more information about Medicare enrollment, volunteer counselors with HICAP in Stanislaus County are available by calling (209) 558-4540. Get free assistance from HICAP counselors in any county by calling (800) 434-0222. Contact the Medicare program at (800)633-4227 or www.medicare.gov.

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