Resources help seniors navigate Medicare options

Dec. 05--PLATTSBURGH -- Medicare Open Enrollment closes Thursday.

If seniors 65 and older want to switch from Original Medicare to Medicare Advantage Plan or vice versa, the time is now.

"When it's open enrollment, anyone can change for any reason," said Marisa S. Pers, services for the aging specialist at the Clinton County Office for the Aging.

"There are a lot of special enrollments that could potentially create eligibility if it's not open enrollment."

BASIC CHOICES

The breakdown for Original Medicare is Part A hospital insurance, Part B medical insurance, Part D prescription drug coverage.

If additional supplemental coverage is needed, seniors can access Medicare Supplemental Insurance also known as a Medigap policy.

"If you have Original Medicare and a supplemental policy and you're traveling, you can go to any doctor that accepts Original Medicare in the United States and they will be happy to accept that payment from the supplemental policy plan that you are enrolled in," Pers said.

"So really, your network of doctors is huge when you're in the supplemental policy because every doctor likes Original Medicare because the reimbursement is very appropriate for them, and that supplemental policy is surely going to pay the rest of that bill. The doctor doesn't have to worry about writing off any portion of it. Keep in mind, if you do travel, supplemental policy may be more appropriate for you. "

Medigap plans are: A, B, C, D, F, G, K, L, M and N.

In Clinton County, insurers include Aetna Life Insurance, Bankers Conseco, CDPHP, Excellus Blue Cross Blue Shield, Global Life Insurance, Group Health, Blue Shield of Northeastern New York, Humana, Mutual of Omaha and United Healthcare (AARP Program).

The Medicare Advantage Plan Part C acts like a HMO or PPO.

Part C combines Part A and Part B, and usually Part D.

But Part D prescription drug coverage can be added if it is not included in some plans.

"If you're very healthy, Medicare Advantage Plans work very nicely," Pers said.

"There's co-pays. The Medicare Advantage Plan actually turns that 20 percent into fixed dollar amounts many times. You know when you go to the doctor, it's maybe a $10 co-pay as opposed to a 20 percent co-pay because we don't know what 20 percent is until we get our bill in the mail. That's another benefit of the Medicare Advantage Plan."

However, if a senior selects a Medicare Advantage Plan, she or he cannot use and cannot be sold a Medigap policy.

Pers cautions seniors not to wait until next year's open enrollment, because she or other counselors at the Office for the Aging or the Joint Council for Economic Opportunity may be able to find seniors a way out of a plan even if it's not open enrollment.

A WIN-WIN

Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York state pharmaceutical assistance program given to seniors.

It provides secondary coverage for Medicare Part D and EPIC covered drugs purchased after the Part D deductible, if any, is met.

EPIC co-payments remain at $3, $7, $15 or $20 based on the cost of the drug.

"Many times it costs nothing to be a member of EPIC," Pers said.

"There's a little hidden jewel in EPIC that you can use as a tool to get where you need to go with your Medicare. That is, EPIC gives you a one-time special enrollment. I want out of this plan and into a more appropriate plan to help with my health-care needs."

At the pharmacy, the prescription drug plan pays first, then EPIC pays, and then the senior pays.

"That means you will have lower out of pocket costs for your medications. EPIC works on a sliding scale," Pers said.

"Most people don't have to pay a fee because of where they're at on that sliding scale. Sometimes, EPIC will pay your prescription drug monthly premiums."

Annual income eligibility is up to $75,000 for a single person and $100,000 for married couples.

"That doesn't mean you are going to get co-pay assistance right away at the pharmacy, but it does mean you will get that special enrollment to change plans," Pers said.

"We find ourselves enrolling so many in EPIC just because we need to change a plan, because EPIC will grant us that right. So, EPIC is a valuable tool to have."

For every program, for example the popular Medicare Savings Program, there are different sets of qualifying factors.

"So we look at your income and we say, 'Are you paying a monthly premium for any health-care plans?'" Pers said.

"If you do, we are allowed to minus that from your income, and that many times creates the eligibility you need to apply for the program."

NEW MEDICARE CARDS

Seniors will receive new Medicare cards starting in April 2018 through April 2019.

"They are going to remove your social security number to protect your identity," Pers said.

"There's going to be a random, 11 digit identifier, and they will consider that your health insurance claim number. It's going to take a whole year for that to occur because there are over 55 million Medicare beneficiaries they are going to be sending cards to."

Benefits will remain the same; only the claim number changes.

"Your social security number is not changing," Pers said.

"Your health insurance number is changing. So people still keep their social security number. It's automatic. The most important thing for people to know about this is there are going to be scammers out there that are going to be calling people. They have already started saying, 'Can you tell me the information on your current card so we can get your new card to you sooner?' If you have that occur, the most important thing to do is not give information and hang up."

Seniors should jot down the scammer's number and contact the New York Senior Medicare Patrol at 877-678-4697.

"Call this toll free number, especially if you get their numbers on the caller ID, and report that so Senior Medicare Patrol can follow up," Pers said.

"Medicare is not going to call you. Social Security is not going to call you. Centers for Medicare and Medicaid Services is not going to call you. So, if somebody calls on the phone and wants to know your information, you're going to hang up. If you move and Social Security is not aware of your current address, then your card might not get to you. So, it's important to call Social Security and update your address if that is the case."

ON CALL

The Office for the Aging is part of the Clinton County Health Insurance Information and Assistance Program.

"Between JCEO and Clinton County Office for the Aging, we're all certified health insurance counselors," Pers said.

"We are all trained by the same people. We all take the same tests. We can all help you, and if we don't know the answer to your questions, we reach up the flagpole and get the answer you may need."

Email Robin Caudell:

[email protected]

Twitter:@RobinCaudell

TO LEARN MORE

Joint Council of Economic Opportunity, 54 Margaret St., Plattsburgh. Phone: 518-561-6310.

Clinton County Office for the Aging, 135 Margaret St., Plattsburgh. Phone: 518-565-4620.

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