Fall time to learn about Medicare

The annual fall open enrollment period for Medicare begins in less than two weeks.

Those interested in learning more about Medicare could take advantage of the free counseling service offered at the Loudon County Senior Center, 901 Main St., Loudon.

"People need help navigating the health care maze because there are a lot of rules and for every rule there are multiple exceptions," Ken Austin, a volunteer State Health Insurance Program counselor at the center, said.

Austin, who worked 30 years in the life and health insurance business, said with Medicare there is no one-size-fits-all plan, but free counseling is available to discover options.

"You might say that your neighbor has a certain plan and it works great for him, but your health, income and other factors may be different," he said.

All U.S. citizens become eligible for Medicare at age 65. Most, unless independently wealthy, must make a choice that can be a confusing decision.

"It's like a new language," Austin said.

At one time there was just Medicare. Today, there is Medicare Part A, B, and D and Medicare Part C, known as Medicare Advantage, which involves private insurance companies.

Medicare A provides basic coverage, including hospital care, for disabled people and those 65 and older. Medicare B provides for doctor visits and some prescription medications. Medicare D is a more comprehensive prescription drug plan.

Nothing is completely free. All plans require copays and deductions depending on a patient's specific situation. For those receiving Social Security, the cost is usually deducted from monthly income.

Medicare Advantage essentially uses private insurance to supplement other Medicare plans.

Open enrollment is the time to make changes and ensure current coverage hasn't been unknowingly altered, Austin said. A person's financial or medical situation can evolve, and health care providers could relocate or retire.

"Your physician may no longer be a part of your plan," Austin said.

Deciding whether a patient is willing to use any health care provider or may want to use a specific physician is a big decision when choosing a plan.

Medicare Part D may or may not cover prescriptions and copays can depend on specific situations. Copays for some medicines can be between $50 and $200. In some cases, the same medicine may only cost $100 without the coverage.

Walking a person through all the issues in a specific health insurance situation takes about 90 minutes, Austin said. Counselors can also detect bad actors who might be guilty of "slamming" or pushing a plan on an unsuspecting customer.

For example, a health insurer should never try to sell a plan over the phone, he said. Austin suggested customers go into the insurer's office or make an appointment to see one of the free counselors at the senior center.

The center also offers other services, Rebecca Wallace, director, said. The center is open all year 8:30 a.m.-4:30 p.m. Monday-Friday and offers exercise classes, crafts, dancing and gospel singing.

The enrollment period for Medicare begins Oct. 15 and ends Dec. 7.