FAQ’s Week of January 25
Q: Why do I have to take a Medicare Prescription Drug Plan? I do not take any medications.
A: If you do not take a Medicare Prescription Drug Plan by the end of your initial enrollment period IEP (3 months after your birth month) or your special enrollment or SEP (63 days from when other coverage has ended) you will be charged a pentalty of atleast 1% for each month you were eligible, but were not enrolled in a plan. If you wait past your IEP or SEP then the only time you may join a drug plan is between November 15 and December 31 each year with coverage beginning on January 1.
We’ll use an example of someone who should have signed up for their drug plan by the end of May in 2008. Their penalty would have started June 1, if they waited until this past enrollment period they would have 19 months worth of penalty or 19%. We come up with 19 months because June to December 2008 is 7 months and then 2009 is 12 months. The penalty is based on the National Average Base Premium which in 2010 is $32. So this person would pay $0.32 for each month they were elgibile, but were not enrolled into a prescription drug plan. 19 x 0.32= $6.08 which would be tacked on to the monthly premium for the drug plan the individual enrolled in. For 2010 the lowest monthly premium is $19.00 so the person would pay at least $25.08 a month for a drug plan.
The penalty does not go away after 1 year. The individual must pay the penalty for the rest of the time they are on a Medicare Prescription Drug Plan. The penalty will increase a little each year becasue the National Base Premium that it is based on increases each calendar year.
Q. Why do they charge a penalty?
A: Medicare is insurance and the penalty is charged assuming that a person has waited until they were sick and needed a lot of medication to enroll. Since the individual had not paid into the system over the years while they were healthy to help build of the “pot” so to speak they are charged more. It’s the same concept as car or house insurace if you wait until after you’ve had a house fire, or after a car accident to purchase insurance then you are going to pay higher premiums.
Q: Is there anyway to avoid the late enrollment penalty?
A: The only way to avoid the late enrollment penalty is to enroll when you are first eligible for Medicare Part D OR apply and qualify for Extra Help through Social Security. Extra Help is a program that assists people who are at 150% of the poverty level or lower pay for their prescription medications. You may qualify if you are an individual and make less than $16,245 per year and have less than $12,510 in resources (this does not include your home or vehicle) a married couple may qualify if they make less than $21,855 per year and have less than $25,010.
FAQ’s Week of January 18
Q: If I am under 65 and on disability when I am eligible for Medicare do I have to take Medicare Part B? I am covered under my former employer.
A: If you are covered by your FORMER employer you will need to take Medicare Part B because Medicare will be primary. Medicare is only secondary if you are covered under you or you spouses’ current or active employment and there are 100 or more employees in the health group. If you have retired or you are not working and your health coverage is through your former employer you must sign up for Medicare Part B.
If you do not sign up for Part B you run the risk of your employer group coverage dropping you or refusing to pay primary for your health care costs. If this happens you will not have primary medical coverage for doctor visits. Then you must sign up for Medicare Part B during the general enrollment period which is January 1 through March 31 each calendar year. Medicare Part B will then start the following July. You may also be penalized 10% of the Medicare Part B premium for each 12 month period you were eligible but did not enroll. When you turn 65 the penalty will go away.
Q: How do I find a doctor or provider that will accept Medicare patients? I’ve called around for days and no one will accept patients with Medicare.
A: Medicare.gov has a physician search tool that will allow you to find a doctor that accepts Medicare. On the home page you will click in the box that says facilities and doctors. Next select the words Find a Doctor you may search for providers by zip code, city, state, county or last name. If you are looking for a physician with a certain specialty you may also select that. The search tool will allow to see if a doctor accepts Medicare or not and whether or not they accept Medicare Assignment. If a physician does not accept Medicare Assignment that means you may pay full price for the service your recieve and then Medicare will later send you reimbursment. A physician may only charge you 15% more than what Medicare would have paid.
Medicare Advantage Plan Open Enrollment
The Annual Coordintated Election Period is over!! I think most SHICK counselors are very glad, it is a very rewarding time of year, but also a very draining time of year. Here at the Sedgwick County Extension office SHICK counselors were able to meet with approximately 1200 Medicare beneficiaries and their caregivers. That is a new record for our office and we are extremely proud of this accomplishment.
Now it is time for the Medicare Advantage Plan Open Enrollment. This enrollment runs from January 1 through March 31 each year. During this time Medicare beneficiaries can make ONE change to their coverage, they may exchange one plan for another, but their coverage has to match. For example, a beneficiary could move from a Medicare Advantage Plan that provides drug coverage to another Medicare Advantage plan that provides drug coverage OR they could go back to Original Medicare and choose a stand alone Prescription Drug Plan or vice versa. The main thing is that this time cannot be used to drop or gain the prescription drug coverage. If you had it on December 31, you will have for all of 2010, if you did not have it on December 31 you cannot join a plan until the next Annual Election period of November 15 to December 31, 2010.
The above rules apply to beneficiaries who are already on Medicare and do not have private insurance through and employer group or union. They also do not apply to someone who has Medicaid coverage.
Walk In Enrollment Day December 4
Due to the fact that SHICK at the Sedgwick County Extension Office is running out of appointments we are hosting a walk in enrollment day. This event will be first come, first served. Counseling will start at 8:30 a.m. and we will go until 3:30 p.m.
A health fair will also be available to participants who are waiting for their appointment.
Please bring your Medicare card and a list of medications with you to the Sedgwick County Extension Office, 7001 W. 21st St N, Wichita, KS, 67205.
December 4 is the only walk in day scheduled. All other days you must have an appointment in order to speak with a SHICK counselor.
New Medicare Part B Premium
The Medicare Part B premium for beneficiaries in 2010 will remain $96.40 for those who have their Medicare Premium deducted from their Social Security. There will be no cost of living increase to Social Security in 2010 so beneficiaries who pay for their Medicare with their Social Security check will not have an increase in their premium.
Those who pay their Medicare by check or EZ Pay or are NEW to Medicare in 2010 will pay at least $110.50 for their Medicare Part B.
Some beneficiaires with higher incomes will pay a higher premium. You may look in the online Medicare & You 2010 handbook on page 119 to see what these premiums would be.
Part D 2010 Kansas Statistics
Fast Facts for Kansas in 2010
● 46 Medicare Prescription Drug Plans (PDPs) available
● 84% of people with Medicare have prescription drug coverage (including 61% with Part D)
● 28% of people with Part D get Extra Help (also called the low-income subsidy, or LIS)
● 100% of people with Medicare have access to a MA plan for a $0 premium
● 100% of people with Medicare have access to a MA plan with maximum out-of-pocket cost limit less than or equal to $3,400
●18 PDPs have $0 deductibles
●$19.00 is the lowest monthly premium for a PDP
● $65.30 is the lowest monthly premium for a PDP with any generic coverage in the Coverage Gap
● 9 PDPs have a premium of $0 for people who qualify for Extra Help
Navigating the Prescription Drug Plan Finder on Medicare.gov
Medicare.gov is an excellent place to find the best Part D plan for yourself or the person you are caring for. This website is the same tool that SHICK counselors use to complete the comparison that we go over for you.
Anyone can access this website and use it to view available plans in your area.
The best way to find a Medicare Prescription Drug plan is to go to the Plan Finder located on the Medicare website. The Medicare Prescription Drug Plan Finder can be found in the middle of the Medicare home page. It is in the Health and Drug Plans Box. Click on Compare Drug Plans.
Once you have clicked on the Health & Drug Plans Button then you can explore the Medicare Health Plan Finder, the Prescription Drug Plan Finder or learn more about drug plan formularies and the coverage gap.
The next page takes you into the plan finder. This page allows you to take many actions. You can continue on to compare available plans, enroll into a plan if you have already selected the plan you wish to enroll in, view the plan you are currently enrolled in, or you can view plans available in your state.
Click on the Find & Compare Plans button to continue to the available plans. The next page gives you two options. You may choose to conduct a personalized search or you may conduct a general search. I reccomened the personalized search if you have a Medicare Card.
The personalized search allows you to see what plan you are currently enrolled in if you are enrolled in a plan, it also shows if you have extra help to pay for your prescription drugs. If you or the person you are working with does have extra help paying for their medications the personalized search will allow the plan finder to adjust plan costs for the extra help. From the review current coverage page you will click continue to enter your medication list.
Click on the gray button that says “Enter My Drugs”. The next page is the drug select page. On this page you can enter the name of each of your medications, or you may search for the name alphabetically. Once you have entered all of your medications click continue. On this page you are be able to enter the dosages of your medications. Entering the dosage is important to determine the correct cost for you. Once you have done this click continue.
This page allows you to save your drug list. Choose a date that is easy for you to remember, such as your date of birth or anniversary. After you have clicked continue medicare.gov generates a identification number to recall your drug list. You may want to print this page and keep a copy for your records. Each time you re-enter the plan finder website you can use this ID number and Password to bring up your drug list. This information is kept forever so you may use it from year to year. Click continue.
The next page is where you can choose your pharmacy. If you live in a rural area you definately want to choose the pharmacy you would like to use to ensure that the plan you choose is accepted at that pharmacy.
Now you can just continue on to the plan data. Once you have reached the plan data you can view the available prescription drug plans.
You may compare up to 3 plans at a time by clicking in the box next to a plan and then clicking on the compare button. Once you have clicked on the compare button you will see the three plans side by side. Each column is one of the drug plans and the rows compare the same information for each plan.
Medicare vs. Medicaid
A question that comes up frequently is what is the difference between Medicare and Medicaid coverage?
Medicare is the federal program designed to insure older Americans 65 and older. You do not have to be low income to qualify. Those 65 and older are automatically eligible for Medicare. Also people who have been determined by Social Security to be disabled may qualify for Medicare.
Medicaid is a state administered program available to certain low-income individuals and families. Each state sets its own guidelines regarding Medicaid eligibility and services, but in general, people who match one of these descriptions may be eligible:
- Aged (65 years old or older), blind, or disabled and have limited income and resources
- Terminally ill and want to get hospice services
- Aged, blind, or disabled; live in a nursing home; and have limited income and resources
- Aged, blind, or disabled and need nursing home care, but can stay at home with special community care services
- Eligible for Medicare and have limited income and resources
- The parent or guardian of a child who is 18 years old or younger and your family’s income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home
- Facing very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled)
Medicare for Caregivers
Medicare has a new website for caregivers. It is full of lots of helpful information for someone who is taking care of a person on Medicare. It has link to helpful forms such as the 1-800-MEDICARE Authorization to disclose personal health information form and many others.
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