Medicare Assistance Program can help people navigate options

OKLAHOMA CITY — About 800,000 Oklahomans are on Medicare, and their ranks may be joined by about 100 people who turn 65 each day in the state.

While many seniors may want to believe that their days of making hard decisions should be mostly behind them, when it comes to Medicare, that's just not the case. In fact, according to Ray Walker, who heads up Oklahoma's Medicare Assistance Program, people need to not only make wise decisions about when and how to sign up for Medicare as they approach 65, but they need to review where they're at with Medicare and make judgments each ensuing year about how to go forward based on how plans or their health or finances might change.

The Medicare Assistance Program can help.

"We're there to help people who have any questions related to Medicare. What is Medicare? How does Medicare work? What are the parts of Medicare? What are your options related to Medicare?" Walker said.

Counselors who have no stake in what decisions are eventually made can help people to understand what traditional Medicare Parts A and B are, how Medicare supplemental insurance works and how Medicare Advantage can be an alternative way to go.

They can also help people to understand what they may need to do if they're planning on working and carrying employer-provided insurance after they turn 65, or what they need to consider if they have other insurance benefits, such as VA or tribal benefits or benefits provided through a pension plan.

What you should know

When people are ready to sign up for Medicare, they should know that:

Medicare Part A is the "hospital insurance" portion of original Medicare. It primarily covers inpatient care, including hospital stays, skilled nursing facility care, hospice, and home health services. Most people get it premium-free because they've paid for it through federal income taxes.

Medicare Part B pays for routine doctor visits, emergency room care, lab tests and for medical equipment. People pay a monthly premium based on their income, but the standard premium in 2026 is $202.90. Additionally, there's an annual deductible. This year it's $283. After that, part B pays approximately 80% of costs, and patients are responsible for the rest. While Part B is optional, most people do enroll. Those who don't when they turn 65 and who don't have any other "qualifying" coverage should know that they'll face higher premiums later for delaying signup.

Medicare Supplement Insurance, or Medigap, can be purchased through private companies in tandem with traditional Medicare to help with deductibles and out-of-pocket costs. Plans are identified by letters A-G, but are basically standardized, so one company's Plan G coverage will be the same as another company's Plan G. Premiums may differ, along with plan availability from state to state.

Traditional Medicare Parts A and B don't cover routine dental or vision care. To get coverage, people typically look for standalone private company policies.

Medicare Part D is an optional, privatized prescription drug coverage program available to everyone on Medicare. The national average premium for a stand-alone Part D plan is roughly $34.50 per month. There are also deductible costs.

Medicare Advantage, also known as Medicare Part C — not to be confused with Medigap Plan C — is more of a managed care option and alternative to Original Medicare. When people enroll in an Advantage plan, they agree to receive their Medicare benefits through that private plan instead of through Original Medicare. So-called "all-in-one" plans that bundle hospital and outpatient coverage usually include prescription drug coverage and often offer extra benefits like vision, dental or even bonuses like gym memberships. There are premium and deductible costs. People who opt for Medicare Advantage can't also get Medigap coverage. However, they can return to Original Medicare if they choose during a future annual election period.

Medicare Advantage

It's typically more expensive to opt for traditional Medicare coverage over Medicare Advantage, but Walker said there can also be significant advantages. One is that traditional Medicare benefits are very portable. A patient can be taken care of, no prior authorizations required, by any doctor or facility in the country that accepts Medicare, and Medicare supplement policies are also universally recognized.

Medicare Advantage plans sometimes come with no monthly premium. However, people can be limited to finding care within very narrow provider networks. That can make some Advantage Plans undesirable, especially for people in rural areas where there may be few, if any providers. Even in urban areas, people can find it difficult to access specialized or out-of-network care. Additionally, there can be cumbersome pre-authorization requirements, and out-of-pocket costs can be unpredictable.

"People are paying less up front, but they're paying more on the back end, whereas (on traditional Medicare with Medicare supplement coverage), you pay more on the front and less on the back end," Walker said. "Also, once you're sick, it's very hard to get a Medicare supplement plan."

Supplemental plans

When people first enroll in Medicare Parts A and B, they have a six-month open enrollment period during which they can enroll in any Medicare supplement (Medigap) plan that's available, and they cannot be denied, even if they have a serious medical condition. Additionally, there's a 60-day window each year, beginning on the individual's birthday, during which every Oklahoman enrolled in traditional Medicare with a supplemental policy can shop around for a better deal on some other supplement policy with equal or lesser benefits.

"And once again, the companies cannot look at their health history," Walker said.

Something else that should factor into decision making is how plans — and perhaps especially Part D drug plans — may change from year to year. Premium amounts and co-pays can change. Drug coverage can change. Pharmacies that companies are contracted with can change.

"So, it's really important that seniors every year review their drug coverage to make sure that the plan that they're on is still the best plan for them," Walker said. "The plan that's the cheapest for you this year may not be the best choice for next year, and you can really save hundreds if not thousands of dollars by reviewing that every year."