Sen. Jennifer Bertino-Tarrant, AARP partner to help explain program
By Andrea Earnest | Bugle-Sentinel Staff
Medicare open enrollment begins this week, and individuals who are new to the federal health insurance program have likely spent the last several weeks doing their research.
To help ease concerns and answer questions, state Sen. Jennifer Bertino-Tarrant and AARP Illinois recently partnered to give area residents an overview of the Medicare program and its coverage options during a Medicare 101 event at Troy Township Community Center in Shorewood.
Attendees to the Oct. 6 event were able to find out more about Medicare and ask questions about the federal health insurance program, which is available to people over the age of 65 and younger individuals with certain disabilities or end-stage renal disease. Medicare open enrollment runs Oct. 15 through Dec. 7. During this time, eligible people can browse Medicare’s new benefits, make changes to their coverage or enroll in a plan.
Courtney Hedderman, associate state director for AARP Illinois, gave an overview of the Medicare program, which she said can seem scary to people who aren’t familiar with its benefits. Once you get it down, however, she said it’s a great program.
Hedderman explained that Medicare does not cover everything, including monthly premiums, deductibles, coinsurance or co-payments, but added that its main coverage options do cover a significant amount of healthcare costs.
Medicare offers several coverage plans, which include Part A (hospital insurance), Part B (medical insurance) and Part D (prescription drug coverage).
Part A helps cover inpatient hospital care, and also includes hospice and home healthcare and some skilled nursing facility care.
“Hospice is something that Medicare does cover completely,” Hedderman said.
Hedderman explained that the monthly premium for Part A, saying that if someone has worked more than 40 quarters of work, their monthly premium is free.
“For someone who has a work history, Part A is free, they’re paying no premiums at all,” she said, adding that someone with little work history could pay up to $400 a month for Part A coverage.
Part B covers medical care, including a portion of doctor visits, outpatient hospital services, certain home health services and Medicare-approved preventive services. For Part B, there is a standard premium of $104.90 per month. For those individuals who earn more than $85,000 and couples who earn more than $170,000, the monthly premium will be higher than the standard premium.
Medicare’s prescription drug coverage, or Part D, offers different tiers of coverage, each with its own list of covered brand-name and generic prescription drugs. The plan places drugs into tiers, and each tier has a different cost.
Hedderman explained that tier one is brand-name drugs, and tier four is generic drugs. She said people enrolled in Part D pay monthly premiums and co-pays range from $5 to $35.
“The more money you make, unfortunately, is going to cost you in the sense of the premium,” Hedderman added.
One resident in attendance asked if Medicare would let you know when you’re getting close to the “doughnut hole,” a term used to describe a gap in coverage that comes with basic Part D plans. When the cap is reached, the beneficiary must pay out of pocket for prescriptions.
Hedderman said Medicare would notify the policyholder, and added that prescription saving programs through pharmacies could help cover these gaps.
Another person in the audience asked Hedderman if it was necessary to enroll in Part D if they don’t take any prescription drugs. She said that many people do not originally enroll in a drug plan but add it to their coverage when they needed medication. This, she said, is a mistake.
“There is a penalty when someone doesn’t enroll when they’re eligible,” Hedderman said.
And that penalty is not only assessed the year the person enrolls, but for the remainder of their life.
“When you’re eligible, you must sign up,” Hedderman added. “Whether you take a lot of prescription drugs or not.”
Additionally, U.S. News and World Report reports that 65-year-olds must enroll in Medicare to avoid a penalty, even if they delay Social Security. The article states that failing to enroll in Medicare during the initial enrollment period will result in a 10 percent increase in Part B premiums for every year you delay enrolling.
The organizers of the event also handed out brochures warning against healthcare scams. According to the document, law enforcement has already spotted scammers claiming they were with the government who are going door-to-door and selling fake insurance plans. Telemarketers also could seek personal information to send a “national health insurance card.” The document states that these pitches are scams and are designed to trick people into losing money or to steal their identity.
Individuals can report scams and frauds through several sources, including the Federal Trade Commission at www.ftc.gov/complaint.