A few tips may help make plan decisions easier
There's more to understanding Medicare parts A, B, C and D than learning the alphabet. But they're an important part of life for many seniors.
Parts A and B comprise traditional Medicare coverage and pay hospital and out-patient medical care. Part C is a private insurance alternative to Medicare, but it is still part of the government plan. And Part D is the prescription program.
Senior advocates say not to delay in reaching out for help during the Nov. 15-Dec. 31 enrollment period for Parts C and D. Seniors who miss the window will have to wait until Nov. 15, 2008, to change plans.
Understand what you're signing, experts say. And if you don't understand, ask a relative, guardian or unbiased advocate.
This year there are 203 Medicare Part C options and 56 prescription plans to choose from.
Yes, it can be confusing, and there are unscrupulous sales people pushing their plans, but there is money to be saved, experts say.
Cam Spencer, wellness coordinator for The Canterbury House, an Episcopalian nonprofit retirement community in downtown Charleston, said she spends about 90 percent of her time helping 250 residents navigate their health coverage options.
Spencer and other area advocates are seeing more interest in Part C Advantage Plans, health care plans approved by Medicare and provided by private insurance companies.
Frank Adams, spokesman for the Lt. Governor's Office on Aging, said Part C is increasingly used in South Carolina. The plans provide Part A and Part B coverage. About half of the plans also cover Part D, the prescription drugs, he said.
Once someone is enrolled in a new plan, the original Medicare plan will no longer pay. Participants will receive a new card to replace their old Medicare card.
Spencer has seen more residents struggle with Part C this year. While some of the plans sound good to seniors, they might not be seeing the whole picture.
For example, coverage for an annual dental exam might not be worth sacrificing coverage of the first 20 days in a nursing home, she said. Some people have signed up for Advantage Plans and are dismayed when their doctor won't accept the plan.
The Office on Aging offers a safety information package called "Be Smart" that provides a list of questions seniors should ask and a place to record the broker's credentials.
If seniors do not have access to the Internet, Adams said they should ask a relative or guardian to find and print the brochure from the office's Web site.
In October, Spencer learned that a broker from North Carolina dropped in on a resident at The Canterbury House and got her to change her plan.
"It is illegal to make cold calls," she said. By law, seniors must reach out to brokers.
Spencer researched and learned the plan that the 88-year-old woman switched to covered only three days in the hospital. While there are many reputable brokers, Spencer said consumers need to keep in mind that brokers represent insurance companies.
Jim and Barbara Hayes of James Island recently sat down to compare prescription plans with longtime friend Vasco Pickett, a semi-retired insurance broker.
"Everybody needs to get enrolled and not throw their hands up in frustration," said Jim Hayes, a retired doctor of internal medicine. "It's something you have to work through." The couple expect to save money this year by changing plans.
Pickett has seen fear and confusion turn people away from making a decision. People who do not have prescriptions also might delay enrollment.
For those who dally, 1 percent of the annual average premium will be added for every month they fail to enroll. Pickett estimated that could add up to $6.25 in 24 months.
For those already enrolled, advocates encourage seniors to comparison shop. Angela Edwards, program manager for Trident Area Agency on Aging, takes calls from the public and helps them compare plans on Medicare's Web site.
By punching in a person's basic information and the drugs they take, the Web site will list plans that offer the best coverage. Premiums range from $15.40 to $99.
About 775,000 South Carolinians age 65 or older are enrolled in Medicare Part D, and between 5 percent and 10 percent are expected to change plans this period, Adams said.
The most talked about, and least understood, Medicare feature is the doughnut hole, or the financial gap in drug coverage.
In 2008, when a patient's drug costs reach $2,510, the patient must pay the entire cost until the total reaches $5,726. Fourteen plans offer some limited coverage during the gap.
In September and October, Spencer met with anxious residents who are facing $500 prescription bills.
Big retailers offering low-cost generics are great, she said. Patients can buy their generic medicine out of their own pocket for about the same price as their copay.
The benefit is that by keeping the drug off their Part D plan, which counts the actual cost at four or five times the copay, the onset of the gap is delayed.
Social Security might help cover premiums, deductibles, copayments and the coverage gap for those who qualify based on income or resources, Edwards said.
The South Carolina Gap Assistance Pharmacy Program, known as GAPS, can help seniors in the doughnut hole who have been denied Social Security assistance, but only a handful of Part D plans work with the GAPS program.
Options are not new to medical coverage for seniors. Before Part D, seniors relied on prescription plans from a number of sources, including pharmaceutical companies.
"It's a matter of knowing the system," Spencer said. "And many of our seniors don't know the system."