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Medicare is a Changing Thing:
Before you undertake any new project, it’s always a good idea to sit down…take a deep breath…and plunge right in. And don’t stress out if you run into problems during the year as your “user friendly” HICAP office is just a “toll free phone call” away at 1-800-434-0222. If you are reading this page, you can consider Medicare your project for 2008. Again, take a deep breath…read over the information below to make sure you are as prepared as you can be.
NEED HELP PAYING FOR YOUR DRUGS IN THE COVERAGE GAP?
Call 1-800-Medicare or go to www.Medicare.gov HOME PAGE. Under Medicare Highlights, scroll down keeping your eyes in the center of the screen until you find
Lower Your Costs During the Coverage Gap (this is the 5th arrow).
What is Medicare? Medicare is health insurance for people age 65 or older and under age 65 with certain disabilities. If you have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) or Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis {ALS}), you will qualify for Medicare almost immediately from being diagnosed. To find when you will qualify, call Social Security Administration at
1-800-772-1213 or visit their website at www.SocialSecurity.gov.
Medicare Part A – Hospital Insurance: If you worked 40 quarters (10 years) in your lifetime and paid into social security, Part A is “FREE.” Call SSA office at 1-800-772-1213 if not sure. Part A includes Inpatient Hospitalization, Skilled Nursing Facility care, Home Health Care, Hospice, and blood.
Medicare Part B – Medical Insurance: Everyone pays for Part B and in 2008 the monthly premium will be $96.40. And if you are one of the lucky people that makes more than $82,000 or more per year as a single or $164,000 as a couple, well guess what? You will pay more for Part B effective January 1, 2008 on out. Call SSA office at 1-800-772-1213 to find out what you will pay in 2008
Medicare Part C – Medicare Advantage (MA) Plans: There are many old and new MA plans in 2008: HMO’s, PPO’s, PFFS, and Special Needs Plans. When you sign up for an MA plan, you are signing your Medicare over to the plan and must follow the plan’s requirements in order to have services covered. The Medicare & You 2008 publication explains the available plans in California in section 4, 106 through 107 M. Call the phone number listed for the plan for details of the plan benefits.
Medicare Supplement (Medigap) Plans: When you sign up for a Medigap plan, Medicare is the primary payer and the Medigap plan is your secondary insurance. There are 12 standardized plans that are sold by private insurance companies labeled A through L. The monthly premium varies between plans and is dependent on the county where you live and your age. If you purchase a Medigap plan after January 1, 2006, a Medicare Part D benefit is not included in your coverage. To get a list of companies that sell these plans, call HICAP at 1-800-434-0222 and ask for a list of Medigap plans in your county.
Medicare Part D – Outpatient Prescription Drug Coverage: This is in addition to your Medicare Part A and Part B. If you sign up for a Medicare Part C plan, that plan may or may not include Part D drug coverage. If it doesn’t include it or you have a Medigap plan, you may want to enroll in a Medicare Part D plan to cover your outpatient prescription drugs. For more information, call 1-800-Medicare, visit www.Medicare.gov, or call HICAP at 1-800-434-0222.
Open Enrollment: Open enrollment for both Medicare Part C and Medicare Part D plans will be November 15 through December 31 each year. Around October 15, you will be able to peruse the www.Medicare.gov website or call 1-800-Medicare to find out what changes will be made for the next year, or look in the back of your Medicare & You publication that is mailed out each year. Once you have made your decision, you can switch to a new plan during open enrollment. Your effective date will be January 1.
If you are not sure whether or not you need a Medicare Part D plan, find your situation below. The Medicare & You 2007 publication’s List of Topics in the front of the book can also help you figure this out, or call HICAP at 1-800-434-0222 for assistance.
Employer Active and Retiree Plans: (Veteran’s Administration, TRICARE for Life, Federal Health Employee Benefit Plan, Railroad Retirement Board, Indian Health Service, etc.) Your current or former employer should have mailed you a notice advising if your current drug benefit is considered “creditable” coverage. If it is, you should not apply for a Medicare Part D plan, and a penalty will not be imposed if your employer drops the drug benefit at a later date and you enroll into a Medicare Part D plan timely.
Medicare Advantage (MA) Plans (HMOs, PPOs, PFFS, Special Needs Plans): For those of you currently enrolled in an individual Medicare Advantage plan (such as Kaiser Senior Advantage, SecureHorizons Senior Advantage plans), your choice will be decided by the MA plan. You will receive a letter from your plan in early November with your new monthly premium, copayment/coinsurance amounts, and deductibles (if applicable). You can switch once a year to another MA plan between November 15 and December 31 (unless you move out of the service area or have another guarantee issue situation). Your enrollment into the new plan will disenroll you from your current MA plan.
Medicare Supplement (Medigap) Plans:
1) Medigap Plan with no Prescription Drug Coverage (Plans A-G): You can keep your current Medigap plan and choose to enroll in a Medicare Part D plan to help you with your prescription drugs. In the Medicare & You 2007 publication, look at pages 103-A to 103-J.
2) Medigap Plan with Prescription Drug Coverage (Plans H, I, & J):
Your choices are: (Do not drop your current plan until the new plan has accepted you.)
a. Keep your current Plan H, I, or J plan with the prescription drug benefit.
b. Keep your current Plan H, I, or J, drop the prescription drug benefit, and purchase a Medicare Part D plan.
c. Switch to one of Medigap plans A through L without prescription drug coverage and enroll in a Medicare Part D plan.
State and/or Federal Programs with Medicare:
1) Medi-Cal (full coverage): You should have automatically been enrolled in one of ten Medicare Part D plans. Make sure your prescription drugs are covered and the pharmacy you want to use is contracted with that plan. If not, you can switch to a different plan any month you want.
2) Medi-Cal with a Share of Cost (SOC): If you met your SOC in any month, you will automatically be enrolled into a Medicare Part D plan and you will automatically get the Extra Help. If not, you should: 1) apply for the Extra Help; and 2) apply for a Medicare Part D plan.
3) Supplemental Security Income and Medicare Savings Programs: You automatically qualify for “Extra Help”, but you still need to apply for a Medicare
Part D plan. If you have a Medicare Advantage plan, see #3 below.
“Extra Help” for People with Limited Income and Resources
(Includes Medi-Cal with a Share of Cost): If you do not qualify for 100% Medi-Cal, you may qualify for “Extra Help” to assist you with Medicare Part D premium, deductible, and coinsurance. The Social Security Administration (SSA) offices are assisting people RIGHT NOW with the application form. Call SSA’s phone number of 1-800-772-1213 or go into your local Social Security office for an application form and/or assistance.
HICAP is currently giving presentations in Lake, Marin, Mendocino, Napa, Solano and Sonoma counties. To find a location for a presentation on Medicare Part D, click on the HICAP Presentation Schedule button to the left of this page to find a presentation closest to you.
HICAP (Health Insurance Counseling & Advocacy Program), a program of Senior Advocacy Services in Santa Rosa, California, assists seniors (65+) and disabled persons (under age 65) with their Medicare issues. HICAP is funded by federal and state grants administered by the California Department of Aging, and is a FREE service. For an individual counseling appointment, call 1-800-434-0222.
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