The ABCs and Ds of Medicare

If you or a loved one is turning 65 years old soon, you may have a lot of questions regarding Medicare and its many plans. Even if you currently have Medicare, the Annual Election Period that runs from Oct. 15 to Dec. 7 allows you to change your health or prescription drug coverage, which means you might have some unanswered questions as well. Thankfully, Val Curtis, central business office director for Texas Health Resources, is here to help.

Every year, Curtis runs “how-to” workshops covering Medicare registration and the accessing of benefits. Although this program is best suited for those about to enroll in Medicare or those who will assist family and friends with Medicare questions, anyone can register for the class.

“I have a feeling the first workshop will be a lot of employees here at Texas Health who are coming to get info for relatives and parents,” Curtis said. “Last year, the audience included people who were getting ready to get on Medicare or who were already on Medicare and they were very engaged in the conversation.”

Curtis’ workshop starts with an explanation of all the different parts of Medicare and what they cover.

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Parts A and B are included in what many call “Original Medicare.” Part A, or “hospital insurance,” helps cover inpatient care in a hospital, skilled nursing facility (SNF) or religious nonmedical health care institution (RNHCI). It also covers home health care. It also covers hospice care, rehabilitation and psychiatric hospital care.

Part B, or “medical insurance,” helps cover physician care, outpatient hospital care and surgery, home health care, durable medical equipment (DME), and ambulatory services. It also covers some preventive services to help maintain your health. These services may include exams, lab tests, screenings, shots and counseling.

If you or your spouse has worked for more than 10 years and paid Medicare taxes during those working years, you automatically receive Part A free of a premium once you turn 65 years old. If you are not eligible to receive premium-free Medicare Part A, you can enroll in Part A and pay a premium.

Most people pay a monthly premium for Part B coverage. The amount you pay is based upon your tax returns. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty fee, which can equate to a 10 percent increase for each full 12-month period you went without it.

Part C, or “Medicare Advantage Plans,” is offered by private insurance companies that contract with Medicare to provide you with all of your Medicare Part A and Part B benefits. These plans usually include Medicare prescription drug coverage (Part D) as part of the plan.

Part D, or “prescription drug coverage,” helps cover the cost of prescription drugs. Just like Part C, it is run by Medicare-approved private insurance companies. Enrolling in this plan may help lower your prescription drug costs and help protect against higher costs in the future. Although it is optional, you may be charged a penalty fee if you want to enroll in it later.

You can sign up when first eligible for Part B. For example, if you are eligible for Part B when you turn 65, the Initial Enrollment Period is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

If you do not enroll in Part A and/or B when first eligible, you can sign up between Jan. 1 and March 31 each year. The coverage will begin on July 1, but you may have to pay a late enrollment penalty. If you opt to change your plan during the Annual Election Period, your coverage will begin on Jan. 1 of the following year.

To enroll, you have three options to choose from. You can visit your local Social Security office, contact Medicare at 1-800-Medicare (1-800-633-4227) or visit Medicare’s website at Medicare.gov. All three are also great sources of information to help guide you in your process of picking the appropriate plan.

Curtis said that although the government does a good job of getting resources out to soon-to-be and current Medicare beneficiaries, sometimes the message isn’t as simple and clear as it could be.

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“The handbooks they send out — that 53-page thing — will put you right to sleep, and the language that they use in that booklet … I just think most people go cross-eyed with it and just kind of throw up their hands,” she said.

If you’re interested in learning more about Medicare, Curtis encourages you to educate yourself about all the plans, to make sure you can still see your primary care physician or visit your local hospital, to know your rights, and to seek help from trusted sources.

“Those are some of the saddest stories I hear from patients,” she said. “They feel like they were scammed by insurance agents. Once they sign up, they realize or they find out later, when it’s too late, that they can’t go to the primary care physician or hospital they’ve gone to for the last 20 years. Those are kind of the warnings that I feel is nice to get out there.”

The workshop Curtis teaches is offered at two locations: Texas Health Willow Park and Texas Health Burleson. The two-hour class goes into more detail over each plan offered in Medicare, what your premiums may look like, your Medicare rights and the exclusions to coverage, to name a few.    

As for how confident workshop-goers feel after leaving the class, Curtis said it’s all dependent upon audience questions and discussion.

“In last year’s class, a lot of them had stories to share, which led into other discussions,” she said. “It was pretty interactive in terms of audience participation, and when they leave, they don’t probably know what they’re gonna do but they have a better feel for what to do and they feel much more comfortable that they’ll be able to make that decision.”

To register for or learn more about the Medicare workshops offered by Texas Health or to learn more about them, visit TexasHealth.org/Classes or call 1-877-THR-WELL (1-877-847-9355).

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