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A program for seniors helps beneficiaries make the most of Medicare

Medicare fall enrollment starts Oct. 15


When that red, white, and blue Medicare card arrives in the mail, it's easy for many 65-year-olds to think that the anxiety over paying for health care and budget-busting insurance premiums is over.

But to get the most out of Medicare, thorny decisions must still be made — and without too much procrastination. For one, putting off enrollment in Medicare Part B, or Medicare Prescription Drug Plans (Part D), or both, could mean expensive lifetime penalties for those who delay past the initial seven-month enrollment period.by: MERRY MACKINNON - SHIBA Coordinator Janet Bowman talks with Rita Bhatia at Multnomah County Hollywood Branch Library where Bowman gave a talk on making the most of Medicare.

Since Medicare Parts A (usually free, but limited to hospitalization, some nursing and hospice care) and B (clinician and outpatient care and preventive services) do not include prescription drugs, many individuals purchase additional Part D coverage, as well as other supplemental insurance. But first they have to decide whether to buy a Medicare supplement plan with Part D or to choose one of the Medicare Advantage plans which cover prescriptions. Most of those plans have a yearly limit on the amount they'll cover for prescription drugs, which means that a "doughnut hole," or "coverage gap," kicks in after beneficiaries have reached that limit for prescribed drugs.

Thus, even when covered for prescriptions, Medicare beneficiaries — especially those who take expensive medications for high blood pressure, diabetes and other conditions — may hit the doughnut hole, usually around the middle of the year. Then they are financially responsible for prescriptions until their out-of-pocket expenses reach $4700, at which point coverage resumes.

"It's sticker shock when you go to the pharmacy and here's a bill you aren't expecting," said Multnomah County's Janet Bowman, Medicare Outreach and Senior Health Insurance Benefits Assistance (SHIBA) coordinator. "Not everyone understands."

To help seniors understand the doughnut hole and other Medicare complexities, SHIBA provides Oregonians with free counseling through a phone line, appointments conveniently held at local senior centers and public sessions offered at libraries and other sites.

For example, to assist individuals on coping with the Part D doughnut hole, SHIBA staff, including Bowman, offer tips, such as talking with your doctor about less expensive alternative drugs or lower cost generics, deciphering Part D plans to find out the plan's negotiated price for drugs, contacting drug manufacturers that offer discounts, and accessing county emergency prescription assistance programs for Medicare Part D beneficiaries with significant out-of-pocket costs.

"Some people come to us because they can't afford rent and their prescriptions," Bowman said, adding that sometimes low-income seniors stop taking their medications because they can't afford them. "It helps to know the path and that there's something that they can do when they're in the doughnut hole."

Over the next eight years, under the Patient Protection and Affordable Care Act, the Medicare prescription coverage gap gradually will disappear, Bowman said. But she doesn't know what will happen if the act is repealed.

Throughout July and August, Bowman spoke at various Multnomah County libraries on "Making the Most of Your Medicare." The hour-long sessions feature information on how to pay less at the drugstore, getting good care and learning about additional benefits for which Medicare beneficiaries qualify, including Medicare's free wellness and health screenings.

Those free or low-cost preventive services include wellness visits, colonoscopies, flu shots, Pap smears, mammograms, bone density tests and other services. Often those on Medicare need to be reminded to take advantage of those preventive services.