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A prescription for right Medicare plan

Being prepared avoids confusion about health care options


Confusion abounds during the Medicare annual enrollment period, Oct. 15 through Dec. 7. That’s when Medicare supplement plan salespeople tell you why their benefits, providers and their service are better than every other plan.

While their sales pitches are closely regulated by the Centers for Medicare & Medicaid Services, potential enrollees still are bombarded by direct mail, TV and radio ads, billboards and invitations to sales presentations. Messages can be confusing, and your request for an information packet will result in a thick package arriving at your doorstep with materials written in Medicaid-approved bureaucratese that can make your head explode.

Beginning in 1965, when Medicare was established, Americans have struggled to understand the program’s growing alphabet of Medicare parts A (“Original Medicare” for hospital and skilled nursing care), B (outpatient and home health care), C (Medicare Advantage Plan) and D (prescription drugs). We can’t fault the government for continuously changing the rules and offerings — billions of dollars and the health coverage of some 50 million Americans are at stake. And it’s no easy task to pay bills, stop fraud, waste and abuse, and still fill the inpatient, outpatient and prescription needs of everyone older than age 65 or disabled.

After working for more than a decade in the Medicare arena as a consumer advocate, and as a consultant to health plans and health care vendors nationwide, I welcome an opportunity to help simplify the process of choosing the plan and program that’s right for you.

n What kind of plan do I need?

That depends somewhat on your level of health and wealth. If you are in poor health, or are concerned that you may have issues in the future, you want more than basic original Medicare. But even for those in good health, one serious illness or accident could leave you with large deductibles and co-pays with only Part A coverage, which has a limit on hospital fees it will cover. That means you may be only one cancer surgery, stroke or heart attack away from wiping out your retirement savings, or losing your home.

That’s why, for most people, having a Medicare supplement plan (such as a Medicare Advantage plan) makes good sense. Your out-of-pocket costs will be so much smaller, hospital fees have a cap, and you’ll likely have better preventive care.

For those who are on a fixed low-income and/or disabled, you may qualify for a SNP (Special Needs Plan), available to those who are “dual eligible” for Medicare and Medicaid (Oregon Health Plan). If so, you would receive comprehensive coverage with essentially no out-of-pocket costs. You might be surprised to discover the benefits available to you. Start with the Aging & Disability Resource Helpline: 503-988-3646.

n How does Medicare work?

Part A is provided to you automatically as soon as you are eligible. But unless you qualify for a low-income subsidy or are eligible for Medicaid, you must pay to receive Medicare Part B. That covers many services, including doctor visits, home care, diabetic supplies, oxygen and other medical equipment and supplies.

People who do not sign up for Medicare Part B when first eligible may be subject to a late penalty, so it is vitally important for you to have a clear understanding of your monthly income and how your assets will be viewed before enrolling in any Medicare program.

n What type of coverage do I need?

Choose a plan that matches your needs, but also promotes wellness and activity. Truthfully, the more you do and the more involved you are in something you care about, the longer you will live. Plan for a potentially long life, because the Social Security Administration says that about one of every four 65-year-olds today will live past age 90, and one out of 10 past age 95.

So search for a plan that you can afford for a long time — but also choose a plan that emphasizes wellness and preventive care, so you can live those years in good health. A Medicare Advantage plan (Part C) probably offers the best combination of benefits and value, with lower monthly fees and prescription costs. Many of the plans also encourage keeping you active and independent, with everything from free concerts to gym memberships.

For those who are eligible, nonprofits like CareOregon Plus provide good plans worth considering. It’s also valuable to talk with a good insurance broker or insurance company representative to find the benefits you need. You can also contact Senior Health Insurance Benefits Assistance program toll-free for help, 1-800-722-4134.

Mara Woloshin of Southwest Portland is with Woloshin Communications Inc., a Portland-area public relations and consulting firm.



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