New
Medicare Benefits for
Presented by Kathy Curtis, Social Security Administration
August 15, 2005
South Des Moines Alzheimer’s Support Group
Notes
Karen said that in
The overview of the Medicare plans:
Medicare Part A = hospitalization insurance. There is no charge for this coverage, and no deductible.
Medicare Part B = doctor visit insurance. There is a minimum monthly premium of $78.20 per month per person, and a late fee penalty if the person signs up later than their point of eligibility. There is a deductible the person has to pay to use this insurance.
Medicare Part D = new prescription drug insurance to cover the price of prescription drugs. There will be a monthly per person premium of approximately $32 per person per month. There will be a co-payment, and there will be an out of pocket deductible that must be met unless the person qualifies for free coverage.
When a person turns age 65, he or she must sign up for coverage. There is a grace period of time both before and after the birthday to sign up without penalty. For parts A and B, the person works directly with Social Security Administration. For coverage with the new Part D, you need to sign up with one of several provider companies who are approved to sell Medicare coverage. The best way to get this information is to work through SHIIP.
Once a person is enrolled with a specific provider, he or she may not change providers other than one time a year at the open enrollment time. The exception is if the person receives Part D without charge and that person can change at any time. It is important to choose a provider that can give you the best coverage for the majority of your medications. Each provider will differ a little in the drugs that are covered and the price they negotiate for the medication, so make sure you choose carefully.
If you currently have coverage for prescription costs, you should get a letter from your former employer / benefit administrator letting you know if their coverage compares with Medicare Part D. If your current coverage is the same or better, there will not be a penalty for not signing up when you are eligible, and you may keep your current coverage.
The law for the age of eligibility for Social Security benefits has changed recently, and the age of eligibility for receiving benefits has gone up. However, the law did not change the age of eligibility for Medicare. Everyone is eligible for Medicare Parts A, B and D at age 65.
Basic Medicare Part D coverage will be approximately $32 a person a month, with a maximum deductible of $250 per year. After that, there is a 25%/75% split of the medication cost up to $2000 of coverage. After that, the person will have to pay all drug costs until the person has had $3600 out of pocket medication costs (a total of $5100 for the year). Above that is considered catastrophic expense, and the government will pay 95% of the costs.
The monthly premium may vary depending upon the plan that you choose. Some plans may not have that gap between $2000 and $5100 costs, and those premiums may be higher.
SHIIP does a good job for individual counseling for helping a person determine which plan will work the best for the person, and for assisting in determining eligibility for the no cost coverage based on economic need.
People with limited income can apply for help in paying their premiums. Help may come in the form of lower co-pay, no coverage gap, or lower premiums. People who might be eligible for help with the premium cost includes those who are already on MedicAid or Title 19. Their benefit covers the cost of the premium and requires only a $1 co-pay for prescriptions. Others may also apply. SHIIP will help you determine if you are eligible for assistance. Don’t assume you don’t qualify. Call SHIIP and ask them to help you complete the application forms, and also help you choose your provider.
Senior Health Insurance Information Program (SHIIP) 1-800-351-4664