Medicare conference combats confusion over plans

Traditional Medicare, Medicare Advantage, Medigap and prescription drug coverage plans add up to a “tough system to navigate if you’re younger, and an even tougher one when you’re older,” Lydia Baker of the Pima Council on Aging told a crowd of about 300 at West Social Center on Thursday.

Baker, the Medicare and health insurance coordinator for PCOA, and Patricia Dorgan, director of services for the group, spoke at the 24th Annual Medicare Update Conference. The same conferences were held in Tucson and Oro Valley earlier this month.

Open enrollment for 2010 for Medicare, the national health insurance program for those 65 and older, runs through Dec. 31. Controversy and debate over federal health care reform legislation, worries about higher premiums, changes in the Medicare system, and the number of plans that have been dropped have generated serious concerns and widespread confusion among seniors.

Baker said that while PCOA and other agencies offer Medicare counseling in Green Valley, it’s impossible to recommend a specific Medicare plan because no one knows what future illnesses may occur.

Consumers who do seek Medicare counseling, she advised, should talk to their doctors and their friends about available plans, read all they can about existing Medicare options and be prepared to provide information on their income and medical history to counselors.

To illustrate part of the problem, Baker said, 58 Medicare Advantage (Medicare replacement) plans sold by insurance companies were available last year in Pima County; 36 are available this year, largely due to a federal decrease in reimbursement for Medicare Advantage. While the plus is that there are fewer plans to navigate, consumers still face hard choices and a bewildering array of details to sort out.

Her advice on Medicare Advantage plans: Get a summary of benefits because each plan has a different mix of costs and benefits. Most have prescription drug benefits. Talk to your doctor and it’s strongly recommended that you look at out-of-pocket costs, which can bankrupt you in the case of catastrophic illness.

The conference program offered an overview of traditional Medicare, Medicare Advantage plans and Medigap plans sold by private insurance companies, which cover gaps in Medicare. but which only work with traditional Medicare, and changes scheduled for June 1 in Medigap.

Speakers also provided extensive information on Medicare Part D (prescription drug benefits) and changes for 2010. Medicare prescription drug plans are those approved by Medicare and run by private companies which add coverage to traditional Medicare and some other types of Medicare plans.

Conference attendees all received a 196-page booklet with up-to-date information on Medicare plans and changes, and an extensive materials and resource guide. The booklet is available from PCOA.

Baker strongly urged those who are already enrolled in a Medicare plan and those approaching 65 to read the booklet because when it comes to Medicare, ignorance is not bliss.

”I’ve met people who have never even looked at their benefits. I look at everything and read everything, but then I lead a very dull life,” said Baker, a former high school teacher who has worked for PCOA for more than a decade.

“If you have learned anything today, it’s that you have to be your own advocate. We can help, but we can’t be with you 24 hours a day.”

For more information on PCOA’s Medicare counseling programs or the conference booklet, call 546-2011.

Among several others, Lynn Henry. 66, of Green Valley, said she found the three and a half hour conference “very helpful and informative.”

Others offered variations on the theme that choosing a Medicare plan is basically a crap shoot, no matter what you do.

“The majority of us who are healthy don’t know what will happen tomorrow. All you can do is the best you can with the information you have.” Henry said.

Kathy Engle is a freelance writer who lives in Amado. You can contact her at kdengle@earthlink.net.

FYI

To learn more about various Medicare plans, log on to Medicare Interactive Counselor at www.medicareinteractive.org, a resource provided by the Medicare Rights Center.

Other Web sites

www.medicare.gov

www.cms.hhs.gov

www.socialsecurity.gov

Fast Facts for Arizona in 2010

46 Medicare Prescription Drug Plans available

80 percent of people with Medicare have prescription drug coverage, including 61 percent with Part D

30 percent of people with Medicare Part D get Extra Help (also called the low-income subsidy or LIS)

100 percent of people with Medicare have access to a Medicare Advantage plan for a $0 premium

100 percent of people with Medicare have access to a Medicare Advantage plan with maximum out-of-pocket cost limit less than or equal to $3,400

17 Prescription Drug Plans have $0 deductibles

$10.30 is the lowest monthly premium for a Prescription Drug Plan

$40. 40 is the lowest monthly premium for a Prescription Drug Plan with any generic coverage in the coverage gap

8 Prescription Drug Plans have a premium of $0 for people who qualify for Extra Help

Plan costs and coverage change each year, so all people with Medicare should check to make sure their plan still meets their needs and budget. There may be a Medicare health or drug plan available with better coverage or a lower deductible in 2010.

Source: Pima Council on Aging

Phone numbers

“Medicare & You 2010 Handbook,” available by calling 1-800-MEDICARE (1-800-633-4227) or on the Medicare Web site.

Social Security, 1-800-772-1213

State Health Insurance Assistance Program (SHIP), 1-800-432-4040

Southern Arizona VA Health Care System Eligibility and Enrollment Center, 520-629-4952

Pima Council on Aging Medicare Counseling, 520-546-2011

TRICARE for Life, 1-877-363-6337

Arizona Health Care Cost Containment System on Supplemental Medigap insurance, (1-800-528-0142)