Turning 65 soon? Here’s what you should know about Medicare

Aug. 23--In health care, the magic number is 65.

Most people who live in America are eligible for Medicare, a federal health insurance program, when they turn 65, as long as they have a Social Security number and have paid into Social Security. It's also available for younger people with disabilities or other chronic diseases.

But Cinia Montoya, a licensed Medicare Advantage Plan insurance agent, finds many people do not know the fine print of Medicare, which can lead to overspending on health care or penalties in the future.

"They receive tons of mail because every insurance company will send somebody who is Medicare-eligible mailouts. Over the years, they don't open them and throw them away," Montoya said. "Under (Centers for Medicare and Medicaid Services) guidelines, agents are not allowed to solicit clients, so it's hard to reach people and why many people don't know about Medicare options."

Medicare fall open enrollment is Oct. 15-Dec. 7 annually. But figuring out the best plan for you, and possibly your spouse, should be done months in advance, Montoya said.

"In Nueces County, we have 18 Medicare plans," she said. "You have to say 'I want my Medicare,' and if you never sign up for it, you pass a window of opportunity."

That "window of opportunity" is three months before and three months after the month a person turns 65. Medicare benefits can begin the month a person turns 65.

A delayed registration could result in a penalty down the line with certain parts of Medicare, including medication-related Part D.

MEDICARE PARTS AT A GLANCE

Medicare includes four parts, each of which cover a specific aspect of health care.

Part A covers hospital care, skilled nursing facility care, nursing home care, hospital and home health services. Part A typically does not require a monthly premium, but there is a yearly deductible, according to Medicare.gov.

Part B covers medically necessary and preventive services, like office visits, ambulance services, durable medical equipment, mental health services and hospitalization and clinical research, according to the website.

Currently, the Part B premium is $104.90 a month.

Part C is a private insurance option, which is where Montoya's services come in. This part's plans are offered through private insurance companies and approved by the Centers for Medicare and Medicaid Services. These also are called Medicare Advantage or Medicare Health plans.

Recipients must be enrolled in parts A or B before enrolling in a Part C plan.

Part C helps cover costs not covered by parts A and B. Medicare recipients are not required to enroll in Part C.

Finally, Part D is Medicare's drug prescription plan. It's optional to those enrolled in Original Medicare and Medicare Advantage plans, and it's also offered by private insurance companies and approved by Centers for Medicare and Medicaid Services.

The drug plan involves a monthly premium and deductible and includes copayments for drugs, according to Medicare.gov.

MEDICARE KNOW-HOW

Residents who soon will become eligible for Medicare can learn more at three Medicare clinic sessions hosted by the Corpus Christi Parks and Recreation's Senior Community Services and the Area Agency on Aging of the Coastal Bend. The first session will be on Wednesday.

The sessions mostly will cover Medicare Savings Programs, which are for Medicare recipients whose income falls below a certain level, according to Lisa Oliver, superintendent of senior community services.

If a person qualifies, the savings program will pay for all of the monthly Part B premium and could pay for a portion of the Part D prescription drug premium.

During similar sessions held this summer, a number of area residents were shown to be eligible for a savings program, Oliver said.

"Many don't know that it's available and that they are income-eligible," Oliver said. "That's $104 going back into your pocket, which can go for food, utilities or the basics of everyday living."

One couple who went to a summer clinic session had a combined monthly income of $900 and both were paying Medicare premiums, she said. They had no idea they could be saving $200 a month by applying for a savings program.

GROWING PROGRAM

According to agency projections on national health expenditures from 2016-2025, health spending growth by federal, state and local governments will outpace spending by private businesses, households and other private payers.

Medicare spending growth may accelerate from 5 percent in 2016 to 5.9 percent in 2017, the report finds.

In Nueces County, private insurance companies enrolled nearly 3,000 people in Medicare Advantage plans in 2015, Montoya said.

The average number of Nueces County residents turning 65 over the next decade will be about 19,000. In 2014, 18,576 people were enrolled in the county, according to a study by Dartmouth College.

However, not all of those people will get on Medicare because they still will be using their company insurance, she said.

"It's all voluntary. We can't recommend any specific insurance provider, we can only show them what their options are," Montoya said.

IF YOU GO

What: Medicare Savings Programs informational sessions

When: 1-4 p.m.

Where: Wednesday, Aug. 23, at Northwest Senior Center, 9725 Up River Road; Thursday, Aug. 24, at Greenwood Senior Center, 4040 Greenwood Drive; Tuesday, Aug. 29, at Lindale Senior Center; 3135 Swantner Drive

Information: All are invited. Call Corpus Christi Parks and Recreation Senior Community Services at 361-826-3132.

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