Tis the Season: Obamacare and Medicare

‘Tis the season of Obamacare and Medicare.  Yes, Halloween is almost starting to feel like stale chicken feed candy and Christmas ornaments have made their way  into some stores here in New Rochelle. Adding to the season, it is almost the start of the annual Medicare enrollment period, October 15-December 7. This should not be confused with Obamacare open enrollment which started October 1, 2013. Those on Medicare remain on Medicare. This helpful article, which appeared in Daily Finance at Aol.com presents important considerations in making your Medicare decisions. I hope you  find the article helpful in deciding whether you need to make changes or your current plan will serve your needs for 2014.

Medicare Open Enrollment Is Here: 3 Must-Know Facts

by Dan Caplinger Oct 4th 2013 6:00AM

On Oct. 1, millions of uninsured Americans got their first chance to sign up for the health insurance exchanges that the Affordable Care Act created. Yet in all the attention that the new Obamacare exchanges have received, another important event for health care coverage has largely gone unnoticed — even though it potentially affects even more of the American public.

More than 50 million Americans are eligible for Medicare according to the Department of Health & Human Services, and every year, Medicare participants get a chance to choose or make changes to their existing coverage options under the program.

With the annual open enrollment period running from Oct. 15 to Dec. 7, those eligible for Medicare — typically Americans age 65 or older — need to be prepared to make smart choices about their coverage.

Here are three things you should know in helping you make your decision.

1. Obamacare Open Enrollment Is Entirely Different From Medicare Open Enrollment.

One major source of confusion among Medicare recipients comes from the fact that the inaugural open-enrollment period for Obamacare is happening at the same time. However, if you’re eligible for Medicare, you won’t get your insurance from an Obamacare health insurance exchange, and if you visit the exchange websites, you won’t find Medicare as an option. Moreover, the insurance policies you will find on the Obamacare health insurance exchanges won’t be appropriate for Medicare recipients, as they won’t take Medicare’s provisions into account.

Instead, the Medicare website is the best place to start in signing up for Medicare or choosing a new coverage plan. There, you’ll find detailed information to help you learn more about your available options and find out about the various plans that are available to you.

2. Changing Plans During Open Enrollment Can Be Especially Smart If Your Health Has Changed.

One of the most important aspects of Medicare open enrollment is that it allows Medicare recipients to tailor their coverage to their particular needs. Although traditional Medicare Part A and B coverage doesn’t involve much decision-making, prescription drug coverage under Part D gives Medicare recipients many different choices. Some Part D plans offer comprehensive coverage of prescription drug costs but at higher monthly premiums, while other Part D plans have much lower monthly costs but don’t pay for as much of your potential prescription-drug expenses.

If your health hasn’t changed much during the past year, you might well find that your existing Part D coverage still suits your needs and therefore won’t need to make major changes. But if your health has changed markedly, requiring you to take new prescription drugs, looking at other Part D plans might save you money. Paying higher premiums might actually reduce your overall costs if a new plan covers more of the out-of-pocket costs of obtaining your prescriptions.

  1. Understand the Medicare Advantage and Medigap Coverage Options.

    Another source of confusion for Medicare recipients involves the difference between traditional Medicare, Medicare supplemental insurance, and Medicare Advantage plans. Traditional Medicare covers you for medical services from any provider that accepts Medicare, but it doesn’t cover all of the costs of those services. In order to cover the rest, those who have traditional Medicare can get Medicare supplemental insurance from third-party insurers, with policies designed to fit Medicare’s broad coverage.

    On the other hand, Medicare Advantage plans often take the place of traditional Medicare coverage, with many plans offering both medical services and prescription-drug coverage in one package. Medicare Advantage plans often involve networks of physicians through health maintenance organizations or preferred provider organizations, so you might not have as much flexibility to choose whatever doctor you like. Assessing the cost differences can be complicated, but the right choice can nevertheless produce substantial savings.

    Make the Smart Choice

    It’s easy to let Medicare’s open enrollment period pass you by without a thought, especially if you’ve largely been happy with your existing coverage. But this is the only chance during the year you have to assess what you’re spending on health expenses, so taking the time to see if a new Medicare coverage option would save you money is well worth the effort.

LTC Insurance: Waiting Because You Don’t Know it’s Time to Begin

As a geriatric care manager, I am sometimes asked to help families throughout Westchester County, initiate their  long term care (LTC) insurance claim. I am happy to assist in this endeavor.  But if truth be told, and I consider myself a truthful geriatric care manager (except for my necessary fiblets, see June 12, 2012 blog), I sometimes wonder why families wait so long to open these policies. Do you really want to continue to pay those exorbitant premiums? Just a reminder, once the claim is approved and the elimination period has been reached, one stops paying the premium. So what are you waiting for?

My experience has taught me that families wait because they don’t know it’s time to begin. And how do you know it is time to begin?  For starters, one should have a copy of his/her policy. It will outline the elimination period, the daily benefit amount, services available, what disabilities must be present and the places in which services can be paid for. Benefits are rendered at home using a home care agency, in an assisted living facility, a day care program or a nursing home.  A diagnosis of dementia is usually an automatic trigger that opens the policy.  Needing assistance with two of the six activities of daily living:  eating, dressing, bathing, transferring, toileting and incontinence is another trigger to get the policy going.

Once you recognize that one of these triggers is present, a call to the long term care insurance company should be made. A benefits analyst will be assigned to you.  A rather thick envelope will arrive with a slew of papers to be filled out. You will have to provide the insurance company with a Plan of Care. This form is filled out by the claimant’s physician.  The LTC insurance company will then send out their own nurse to do an evaluation.  Documents will be reviewed, and a decision made.

So what can be the worst that can happen if you endeavor to open a claim? Rejection. However, all is not lost. You will have gained a familiarity with your policy and will get a better idea when the time is right. If you excuse this geriatric care manager’s inventive analogy, it’s like having a cataract. The ophthalmologist will tell you when the time is “ripe” (their medical term, not mine) to have it removed.  The same is true for initiating a LTC insurance claim. The right time will come. And the only thing that will be removed are those costly semi-annual premiums. A win-win situation.