SENIOR SPOTLIGHT: All about Medicare

Maureen Wendt

 

Will you be eligible for Medicare this year? I encourage those of you who will be (and your spouse or loved one) to attend "Medicare 101" to learn more about Medicare eligibility and enrollment. This informative workshop will be offered on June 11 from 5:30 to 6:30pm at The Dale Association, 33 Ontario St., Lockport.

Admission to the workshop is free. The presenters are Michelle Farina, Medicare sales representative with BlueCross Blue Shield of Western New York, and John MacDonald, partner in Harbortown Financial Group. Light refreshments will be served. Please call 433-1886 to reserve your seat.

Medicare provides health insurance for persons 65+, certain disabled persons and those in End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The Social Security Administration takes applications for Medicare and provides information. To avoid penalty, apply within 3 months before your birthday month and 3 months after your birthday month.

Medicare has four types of benefits:

Hospital Insurance (Part A) helps pay for inpatient hospital care, limited inpatient care in a skilled nursing facility, home health care and hospice care. Part A has deductibles and co-insurance.

Medical Insurance (Part B) helps pay for doctor's services, outpatient hospital services, durable medical equipment and a number of other medical services and supplies that are not covered by Part A. Part B has premiums, deductibles and co-insurance that you must pay yourself or through coverage by another insurance plan.

Medicare Advantage Plans (Part C) are health plan options that are approved by Medicare and run by private companies. Some of these plans require referrals to see specialists. In many cases, the costs of services (co-pays) can be lower in a Medicare Advantage Plan than they are in the original Medicare plan with a medigap policy. Medicare Advantage Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically necessary services. They generally offer extra benefits, and many include Part D drug coverage. These plans often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.

Medicare Prescription (Part D) is prescription drug coverage for everyone with Medicare. This coverage may help lower prescription drug costs and help protect against higher costs in the future and give you greater access to drugs that you can use to prevent complications of diseases and stay well. If you join a Medicare drug plan, you usually pay a monthly premium. These plans are administered by private companies approved by Medicare. Part D is optional. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later. There are two ways to get Medicare prescription drug coverage:

1.) Join a Medicare Prescription Drug Plan that adds drug coverage to the original Medicare plan.

2.) Join a Medicare advantage plan that includes prescription drug coverage as part of the plan. You get all of your Medicare coverage through these plans, including prescription drugs.

For more information about Medicare on the web, go to: http://www.medicare.gov.

At the end of last year, I needed to assist a loved one in making a Medicare plan decision. I really encourage those of you in the same position to take advantage of the community resources that are available — such as the professionals who will be providing the informative workshop about eligibility and enrollment on June 11th. You will have an opportunity to learn and ask questions.

Maureen A. Wendt is president and CEO of The Dale Association, a non-profit organization that provides senior, mental health, in-home care, caregiver support services and enrichment activities for adults. For more information, call 433-1937 or visit www.daleassociation.com .

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