Senior Life Matters
Understanding Medicare Part D CoverageBy Janell Sluga
As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms, prices and products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
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Question: I am having a hard time understanding Medicare Part D. How do I know if I have coverage or need to join?
Answer: Medicare Part D is different than the other Medicare coverage. Let me give a brief overview.
Medicare Part A is hospitalization coverage. This insurance covers everything that happens during a hospital stay. Medicare Part A can also cover part of skilled nursing facility stays, Hospice and Home Health Care.
Medicare Part B is medical coverage. This insurance covers those medical issues that happen outside a hospital stay. This is for doctor visits, specialists visits, immunizations, outpatient testing, lab work, etc.
Both of these insurance products are the same for everyone. Regardless of your age, illness or where you live, your insurance coverage is exactly the same once you are eligible for Medicare and enroll.
Medicare Part D is different. I compare this product to auto insurance. New York state does require you to have auto insurance if you have a car, but you don't buy it or get it from the Department of Motor Vehicle. You go to or call an independent insurance agent who works with you to get the coverage you need for your vehicle and the type of insurance you need. Medicare has made the rules for Medicare Part D plans - the minimum levels of coverage. Some companies offer you more coverage than the minimum. You do have to have Medicare A or B or both to be eligible to get Medicare Part D.
With Medicare Part D, the tools we have to determine the coverage that works best for you can be found at 1-800-MEDICARE or www.medicare.gov. When you use these tools, the computer program that Medicare designed will help you to figure out what coverage works best for you. The information you need to provide includes where you live - your ZIP code - and what medications you take. This information is entered into the computer program, and then the computer program lists the plans that are available to you in the most cost effective manner.
Add to this mix the Medicare Advantage Plans, and there are 34 that provide drug coverage and you get quite a confusing list of options and alternatives. When trying to determine if you have Medicare Part D, I usually start with looking at your insurance cards. Go ahead pull them out of your wallet. If your health insurance plan is an employee or retiree plan, you probably don't need Medicare Part D. If you don't have employee or retiree coverage, then look at your prescription card. If it is an approved Medicare Part D plan, it will have a MedicareRx logo on it. It will also have a series of numbers under the logo - CMS-S5??? ???. This is your plan ID number for Medicare. The question marks represent the different ID numbers that plans have. They all start with S5. If you find these markings on your card, you have Medicare Part D.
Employee/retiree coverage and Veterans Benefits are not Medicare Part D. If you have any of these types of insurance, you may not need Medicare Part D. EPIC is not Medicare Part D. If you have EPIC, most individuals save even more money by also joining Medicare Part D, and EPIC now requires most individuals to join a Part D plan. EPIC in most cases will help you pay for Medicare Part D by either paying all or part of the premium for you, or reducing your deductible to offset the cost of the additional premium.
The reason this is so important at this time of year is that now is the annual open enrollment period for Medicare Part D, giving you the opportunity to switch from one plan to another or join Medicare Part D for the first time. Open enrollment continues through Dec. 31. This happens each year, and this is the time when you choose your plan for the coming year.
If you have a Medicare Advantage Plan like an HMO, or PPO or PFFS plan - look on your card for those logos - you have an additional enrollment period of Jan. 1 to March 31 each year.
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Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing. She has worked in Chautauqua County with Seniors for more than 16 years. She is HIICAP - Health Insurance Information, Counseling and Assistance Program - counselor trained by Office For the Aging.
You may submit questions to be answered in later columns to Janell Sluga, at Senior Life Matters 737 Falconer St. Jamestown, NY 14701 or by e-mail at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.
