Dual Eligible Increase Benefits

I just recorded a radio ad this week. It begins with an alarm clock ringing, then "Attention Kern River Valley." I go on to say that there are plans available for people on Medicare and FULL Medi-Cal, which are more than likely better than the plans they may currently have.

There were several changes in the regulations earlier this year, and then recently, the Inflation Reduction Act, which will provide lower costing drugs in some classifications. The HMO plans charge no monthly premium, but they are far from "free." Medicare pays in excess of $1,000 per month for the health care costs incurred by you on your plan. The plan gets over $12,000 from the government and with this money they "manage" your health care, trying to keep costs down while maintaining or improving your health.

Between Medicare and Medi-Cal, the "Dual Eligible" person gets most of their care at no out-of-pocket cost. Doctors, hospitals and many extras are included on most plans. To keep people healthy, several private plans are providing more, and in some instances, much more.

All plans allow you to choose your primary care doctor. Most of our local people will have chosen the offices of Dr. Finstad, Dr. Mongar or Dr. Abrahamson. Most will be working with a nurse practitioner (NP) or a physician assistant (PA). To control costs, (managed care) the primary care physician (PCP) may need to refer a person to a specialist. When we review a candidate's situation, we take this into account in recommending a Medicare Advantage plan. We look at your medications and calculate what these medications will cost you if you use a local pharmacy or mail order.

These plans want to keep you healthy. Several have stepped outside the box in offering many non-traditional additional benefits at little or no charge. Things not covered by traditional Medicare (referred to as "Original Medicare") include routine eye exams and glasses, hearing exams and hearing aids, some dental, home delivered meals, transportation, groceries paid for by a refillable debit card (for qualified people) and so many more! Most plans offer gym memberships, and even chiropractic and acupuncture.

The cost of incidentals at the grocery store can become a real dent in one's budget. Over-the-counter medications are available by most plans in varying amounts. You get money added to a gift card or a catalog each calendar quarter helping stretch the budget.

There were several changes in the law regarding the dual eligible, and some plans were discontinued. The insurance company didn't want to lose your business, so they moved you to a plan that they offer. This does not necessarily mean that it is the best value for your needs. Will your doctors still be available? Will your medications be covered, and at what cost?

There are several programs which may qualify a person to be a dual eligible. And even if not qualifying for Full Medi-Cal, they can still reduce your prescription costs. You can be in a Medicare Advantage plan or a stand-alone PDP plan.

Medicare Savings Plan or MSPs help millions of Americans access high-quality health care at a reduced cost, yet only about half of eligible people are enrolled. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance and co-payments for those who meet the conditions of eligibility. Stay tuned to NEXT WEEK where I will elaborate on the MSP program in California. I am here to help, but only if you ask.

Harry P Thal, the Medicare Guru, can be reached at (760) 376-2100 or (800) 498-8425.