Retirement = My Medicare Primer
October 7, 2021
by Jody Moss, Olympic Area Agency on Aging
Medicare is about to become part of my life and is probably already part of yours. But it never hurts to review. In fact, you need to complete a yearly review. Medicare, and specifically Medicare Part D is not a one and done activity.
But I am getting ahead of myself. I am retiring on December 31st, 2021. I will quit work forever! I had to say that because I have been waiting to say that for my whole work life. Don’t get me wrong, I have loved my job, in fact, I have loved every job I have every had – let’s just list them out. Candy stand at a theater (watched a LOT of movies), lead server on the college food line (breast or thigh?), Respiratory Therapy Technicians Assistant, Ombudsman at Cleveland Clinic, Director of Customer Service at Duke University Medical Center Outpatient Clinics, Youth Mediation Coordinator, Healthy Communities Coordinator, Director of United Way, and finally, Director of Contracts Management and Planning. I’ve lived in Ohio, North Carolina and here in Washington.
I have had a diverse and interesting work life and I have had positions where I have been able to improve people’s lives with my work. Okay so maybe the above list is a little bit of boasting, but we all tie some of our ego to our work. My ego will soon need to discover some other ego boosting boasting. I am also listing all these professional titles as evidence of my intelligence – more on that later.
But back to retirement – now it is time to not work – as mentioned above…quit work forever. You’re not the boss of me anymore, I am the boss of me. Oh, and do I ever have plans. The house, the crafts half done, the garden, the weeds, never quite gotten to, travel (well maybe later), books, kids to visit. But mostly I am thinking about getting up when I want to and doing what I want to when I want to do it.
Wow! Sounds almost selfish! I am loving it!
But first there is Social Security and Medicare to get through. Today, let’s talk about Medicare.
I have been asking around – tell me what I need to know? And here is the first thing I have learned. It’s complicated. And by complicated, I mean changing every year, and it is a system built on a system built on a system built in a system.
I signed up for Medicare Part A at 65 easy – peasy – no added cost, no fuss. Now a few years later, I need to get on board with Medicare Part B and decide on a supplemental plan for Part D, or whether I want a Medicare Advantage Plan. And for folks who have a more limited income there are Medicare Savings Plans that can help with expenses. I don’t fit in that category, so I am going to have some expenses that I need to figure out and add to my budget.
I set up a time with my husband to talk to our State Health Insurance Benefits Advisor program staff. Our SHIBA staff showed me material which initially (and still is ) making my eyes cross.
Now I am a very smart woman – see the list of jobs above. I know I can figure this out. And I know who to call. I have people, you know. My very first thought was how do people who are less knowledgeable about the system than I am ever figure this out.
Not that I am losing any mental acuity, but as I age, I expect that eventually that may happen – why did we design such a complicated system for people who are aging, who may always be a few steps out of synch with the latest technology?
But here we are.
So, let’s simplify.
Medicare A – think hospital charges for hospital services, but not for doctors’ services while in the hospital. Usually, there is no premium fee for Medicare Part A plans because we (or our spouses) have worked for 40 quarters or more (that translates to 10 years). Medicare Part A also pays for hospice, and home health services, and short term skilled nursing services, but not long term care services. But there are charges like deductibles for each hospital stay in a benefit period, and they vary based on the length of the hospital stay.
This all means you better “stay” healthy.
Medicare Part B – think outpatient clinic visits, other professional services provided on an outpatient basis, and professional charges for services when you are in the hospital (the anesthesiologist or radiologist) for example). There is a monthly premium fee for this plan that is deducted out of your monthly Social Security payment. There are also out of pocket costs for services you receive – an annual deductible and a 20% co-pay of an approved amount. To purchase any of the additional plans listed below you need to have both Medicare Part A and Medicare Part B.
Medicare Part C – These are the Medicare Advantage Plans – they may cover some or all out of pocket expenses not covered by Medicare Part An and Part B. The Medicare Advantage plans are often a type of managed care plan with some limitations on in-network providers or additional expenses for out of network services. There will be 5 Medicare Advantage Plans available locally in January 2022. Two of the three Advantage Plans available in our region include prescription coverage check to determine if the plan you wish to purchase covers prescriptions. If you opt for an Advantage Plan you can’t purchase or use a Medicare Supplemental Plan or a Medicare Part D Plan. Medicare Advantage plans may also include extra benefits and services intended to reduce your care costs and promote health.
Medicare Supplemental (Medigap) Plans – Medicare Supplemental Plans generally pay a portion of Medicare Part A & B deductibles and copays. There are 10 Medigap Plans listed as A, B, D, G, K, L, M, N, C, F. Plans C and F are only available to those who qualified for Medicare before 2020. Different Insurance companies offer these plans for varying prices. However, all A Plans are the same, all B Plans are the same, etc. So, evaluate the plans by what benefits you want and what you can afford. Then you can determine which of the insurance providers in our region are offering you the best deal. Again, if you have a Medicare Advantage Plan, you cannot purchase a Medicare Supplemental Plan.
Medicare Part D – These are the Prescription Plans, and each plan has its own formulary or list of prescriptions that it will cover. These plans can change at any time, so it is a good idea to review them at least annually. You may not purchase a Medicare Part D Plan if you have prescription coverage through a Medicare Advantage plan.
The above simplified information is really stripped down to essentials – hard to believe there is a more complicated version, isn’t it? There are a lot more details and some are important, like you need to sign up for a prescription plan within the first 6 months of becoming eligible for Medicare Part B or you will pay a penalty fee for the rest of your life! Or, if you sign up for a supplemental plan in those same first 6 months there will not be a required health screening the results of which could lead to your not being able to purchase your selected plan.
Now, here is the important part for all of us, not just us newbie Medicare peeps: Medicare Part C, and Part D plans can change at any time during the year. So, each year it is important to determine if your Advantage plan still covers the services you wish to receive, and still has the in-network providers you want to see, and still covers the medications you are prescribed. Or if there are any new Advantage Plans. Same is true for the Medicare Supplemental Plans and Medicare Part D.
Medicare’s Open Enrollment period occurs between October 15th and December 7th every year. It is a good time to complete this annual review.
At the website www.Medicare.gov, you can click on Preview 2022 Health and Drug Plans, enter your prescriptions, and select mail order, and/or select local pharmacies and you will receive some comparison costs. You can look at a comparison between Medicare Advantage Plans and Medicare Supplemental Plans at this website: https://www.insurance.wa.gov/sites/default/files/documents/ma-medigap-compare-chart_1.pdf
If that is difficult for you, you can contact the Office of the Insurance Commissioner and talk to a Statewide Benefits Insurance Advisors (SHIBA) at 800-562-6900. Locally, SHIBA volunteers will be holding SHIBA Clinics at various places. Because of COVID-19, the protocols for these meetings have changed to protect both clients and the volunteers. All of the volunteers are vaccinated. O3A asks that only vaccinated individuals seek help through the following face to face meetings. Please bring all your medications with you. If you are unable to wear a mask or are unvaccinated, please call 360-452-3221 to have a SHIBA volunteer call you back and talk with you by phone.
These meetings will take place throughout October, November and December 7th.
• Shipley Center in Sequim – 9:00 am to 12:00 pm on October 19, November 2 & 15, and December 7
• Port Angeles Senior Center in Port Angeles – 9:00 am to 12:00 pm on October 15 & 29, November 5 & 19 and December 3
• Port Townsend Senior Center in Port Townsend – 12:00 pm to 3:00 pm on October 19, November 2 & 15, and December 7
• Tri Area Community Center in Chimacum – 9:00 am to 12:00 pm on October 26, November 9 & 23.
• Quilcene Community Center in Quilcene – 10:00 am to 1:00 pm on October 27 and November 24.
• Call 360-374-9496 to get help in Forks.
And by the way, we need SHIBA volunteers – we will train and support you in this endeavor. People love their SHIBA volunteers. My husband was a volunteer in between jobs for a short time and he loved doing that. He says he is going to do that again when he retires. And it makes you smarter about Medicare so you can help people like me.
After all my research, I am left with the thought that Medicare is such a simple idea – health insurance for those of us who are no longer working and able to get it through our employer. Why did they have to make it so dang complicated!?!
Jody Moss is the Director of Contracts Management & Planning for the Olympic Area Agency on Aging and can be reached at 360-379-5064. For help with senior or adults with disability questions call Information and Assistance at 360-452-3221 in Clallam and 360-385-2552 in Jefferson.