By Sheila Harris sheilaharrisads@gmail.com
For residents approaching their 65th birthdays, the opportunity or obligation — depending on a person’s perspective — to enroll in the federal government’s Medicare program is also approaching.
Welcome to the world of complicated insurance options!
The original Medicare, Parts A and B, which apply to hospitalization and medical coverage, respectively, are federal benefit programs funded by taxes paid in by citizens throughout their working years. However, as with other benefits that are administered by the government, rules apply.
Residents must enroll in Medicare within three months of their 65th birthday – either three months before or after — or they will face long-term financial penalties, per month, for late enrollment. Medicare enrollment can be accomplished through the Social Security Administration’s website.
According to experts at Healthline Media, a person can opt out of Medicare altogether, but it’s complicated, they say, and can involve the discontinuation and repayment of Social Security benefits, an unpleasant thought which makes Medicare enrollment look attractive by comparison.
In a world fraught with possibilities for financial missteps, an array of bewildering choices will face seniors as they move forward with Medicare enrollment.
Because original Medicare Parts A and B do not provide coverage for vision, dental, hearing and prescriptions, it’s necessary to enroll in parts or plans beyond the basics for those coverages, say sources from Healthline and Investopedia.
Unlike Medicare plans, which are government-funded, Medicare Advantage plans are provided by private insurance companies, a fact which presents pros and cons. Although vision, dental and prescription coverage is available through Medicare Advantage (a.k.a “Medicare C”), a drawback is that a person’s choice of physicians and hospitals is limited by the extent of the insurance company’s providers. On the other hand, Medicare can be used nationwide, says Healthline, a plus for those who keep the roads or airways hot.
With both Medicare and Medicare Advantage, premiums, copays, coinsurance payments and deductibles vary, so exhaustive (and exhausting!) research must be directed toward finding the policy you believe will best suit your individual needs.
Cassville chiropractor Chad Johnson, of Johnson Chiropractic, believes that Medicare Advantage health plans for seniors do not always live up to people’s expectations when they sign up for them.
“We have had senior citizens come to our office for treatment, then discover that their health plans do not cover chiropractic services,” he said. “People opt for a Medicare Advantage plan because they’re told there’s no deductible, but then they learn that the plan doesn’t cover some types of treatment, like chiropractic services and physical therapy.”
The devil, it seems, according to Johnson, is in the details.
Chandler Young, a licensed Health and Life Advisor, with Insurance Specialties in Purdy, said with most Medicare Advantage Plans, there are copays for services as you use them, if you use them, during the calendar year.
“Those copays apply toward an out-of-pocket maximum for the calendar year,” he said. “Medicare Advantage plans can and do vary from plan to plan, and year to year, depending on which plan a Medicare beneficiary selects.”
Young says Medicare Advantage plans must provide all of the services that are provided to a beneficiary on original Medicare and can provide more.
“However, beneficiaries who choose Medicare Advantage plans may be required to use in-network providers or get prior approvals for certain services,” Young said. “Just like individuals, not all Medicare Advantage plans are exactly alike, so it’s important that beneficiaries meet with a licensed health insurance agent who is certified annually to offer Medicare products to evaluate which option is best for them and their situation.”
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