Understanding Medicare

TELL CITY — Adam Evrard came to speak to the Kiwanis Club about the ins and outs of Medicare. Evrard is a freelance Home Mutual agent who considers himself an old soul. His job is to water down Medicare terminology to help seniors make an educated decision on their insurance coverage.

"It's tricky. I take the courses to understand it, so you don't have to," said Evrard.

Evrard stated that there are so many letters in Medicare, it can be confusing. People come to him wanting certain coverage without understanding what they are asking to add.

Part A is the hospital coverage. Part B is what you actually pay for; it's the doctor visits.

Medicare is 80/20. He said that if an individual doesn't want to take the gamble, they can end it right there and just know that they are 80/20.

Medical debt is the number one reason for bankruptcy for people 55 and older. Evrard said that knowing how to make the right insurance choices could help avoid accruing outstanding medical debt.

Once Medicare is in place, there are two options to choose from and Evrad's job is to explain them. He wants everyone to feel comfortable with their knowledge on the subject and from there, he will help facilitate the need that best fits the individual. This is something that Evrard likes to revisit with his clients once a year due to changes that may be taking place in someone's life. What they need now may not be what they need five years from now.

Option one is to get a drug plan and a Medicare supplement plan. This is the traditional F and G plan that people hear about but Evrard said that F is no longer an option. G is the next best thing. It pays everything that Medicare doesn't. The tradeoff is that a supplemental plan goes up every year with age and can even go up with a zip code increase. It can be fairly expensive to start out.

Option 2 is what is refered to as C or an advantage plan. This is for low-income individuals.

Part A, there is a premium of zero dollars a month. This is the coverage that is given to people. This is the result of paying Medicare taxes throughout the years.

The Part B is the part that people have to pay to receive. The premium may be higher if an individual doesn't sign up for Medicare whenever they are first eligible. This happens often. People tend to wait until a couple days after their birthday, when in reality they should have signed up the first day of their birthday month.

The only deductible for Part B is the $203 for the supplemental. Once that is paid, the individual is done for the year.

The next most important thing Evrard said is that people understand that Medicare pays for only 100 days of long-term care. After the 100 days, a person will be writing a check. An additional long-term care plan is necessary. The younger you are when you get the coverage, the less that is paid.

"It's the final step in the financial planning. This is to protect what you have worked hard for over the years," said Evrard.

Evrard said that women are three times more likely to go in a nursing home. They are more prone to Alzheimer's and tend to outlive men.

Medicare doesn't cover dental, drugs, healthy groceries or a gym membership. A Medicare advantage plan adds these things.

A Medicare prescription drug plan is the trickiest. Once the company and individual reach $4,000, they get moved to what is called the donut hole. The person is now paying 25% of the cost of the drug. Once the person reaches $6,500, they will begin to pay anywhere from zero to $10 for their prescription drug. This typically occurs toward the end of the year and then the cycle starts over when the New Year begins.

The Annual Enrollment Period (AEP) is from Oct. 15-Dec. 7. This is when people 65 and older are able to make any necessary changes to their plan.

The Open Enrollment Period (OEP) is from Jan. 1-March 31. This is only to move an advantage plan to another advantage plan.

The Special Election Period (SEP) is when someone is aging into Medicare or when someone is retiring. The enrollment period is 90 days, either 90 days before or after their SEP is when this enrollment happens.

"Find someone you trust. Let them educate you before you make your decision. If someone wants you to sign up that day, run. Talk it out and think through it before making a final decision. Don't get rushed into a plan," said Evrard.

Evrard can be reached at 812-547-2363 or [email protected].