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LAST CALL FOR MEDICARE OPEN ENROLLMENT – Keystone Elder Law – Mechanicsburg, PA

This article is targeted at those who are eligible to receive Medicare. I am a couple of years too young for that. The bad news for me is that the 2017 cost of medical insurance for my wife and me will increase almost 50%!  The combination of our insurance payments and out-of-pocket minimum payments will be more than $35,000 per year if we do not change insurance companies.  The good news is that, although the premium expense will increase on January 1st, we have until March 1st to enroll in a different plan.

For those who are age 65 or older, the Medicare deadline is different and earlier.  Medicare’s open enrollment period began October 15th and ends, twelve days from now, on December 7th.  It is immediately necessary to pay attention to the fact that the cost of your current Medicare coverage probably will increase and your benefits might decrease.

For those who receive free coverage as part of their government retirement plan, you might not be affected. However, most retired persons have an opportunity to make a choice about Medicare now.  If you choose to ignore this opportunity, you choose to accept the increase in price and loss of coverage that could occur in relation to your Medicare plan.  Do so at your peril.

If you are age 65 or older, and you are receiving retirement benefits from Social Security or the Railroad Retirement Board, you are eligible for Medicare Part A without having to pay premiums. Part A helps to cover hospital care, hospice care and some home health care.

Most persons also elect to participate in Medicare Part B.   It helps to cover medically necessary doctors’ services, outpatient care, some of the services of physical and occupational therapists, and some home health care.  The typical cost of this has been $104.90 per month, which often is deducted from an individual’s monthly retirement pension.

Now you have the opportunity to reevaluate your “Advantage plan” (Part C), supplemental plan, or prescription drug plan (Part D).   Not everyone needs to make a change.   Begin by looking at the information that you should have received by now from your current plan, which might be labeled as “Evidence of Coverage” or “Annual Notice of Change.”

Perhaps your needs are changing. As a person ages, even if one’s current health is pretty good, it becomes increasingly likely that an event could occur which involves a need for hospitalization and subsequent rehabilitation.   Common causes for this are an orthopedic surgery to fix damage caused by a fall, or a stroke that requires physical, occupational or speech therapy to recover.

If neither you nor your spouse have experienced this type of event, maybe you should consider that the insurance companies which study the probability of such events have cited the age of 81 as the time after which such an event becomes more likely than not. While you do not need to fear that possibility, you would be wise to plan for it. The way you do this is not only to research whether your primary physician(s) will participate with your insurance provider, but also to make sure that your insurance provider has adequate rehabilitation facilities which participate.

A few years ago, one of our regional insurers, whose “Advantage” coverage plan had a rich and heavenly sounding name, only included two or three rehabilitation facilities for all of Cumberland County. Worse yet, the only facility they insured which offered a long-term care option was located over 40 miles and 45 minutes away from some of their customers. To top it off, that facility was one that had the region’s lowest ratings. We have not researched all the plans and their rehabilitation options this year.

Research whether your Medicare Advantage coverage includes a rehabilitation facility that you would consider using. Most plans offer good options for short-term rehabilitation, such as a sub-acute hospital. Make sure that your Advantage plan also includes a facility that is acceptable which offers both rehabilitation and long-term care.

No Advantage plan will pay for longer than 100 days in a long-term care facility, but in case a person’s rehabilitation is unsuccessful, it is important that the rehabilitation facility also have long-term care beds and will accept Medicaid as payment for them. If the possibility of a long-term care stay at a facility seems too negative to imagine, remember that insurance planning for a downside such as a house fire or serious auto accident is a wise standard.

The Pennsylvania Department of Aging funds a program called APPRISE to help you to understand Medicare so you can be equipped to make a decision about what option seems best for you. Locally, it is administered by Cumberland County Aging & Community Services, which has scheduled an informational session for Monday December 5th from 9:00 am – 11:00 am at their office at 1100 Claremont Road in Carlisle. Topics include: Medicare Part A and B, Medicare Part D, Medicare Advantage Plans, Supplements/Medigap, Medicare coverage options, state and federal programs that help lower costs for Part B & Part D.  Their website says that registration is preferred, as seating is limited.  Call them at 717-240-6110.

Some independent insurance consultants accommodate individual appointments with persons who are interested in buying Medicare supplemental coverages. If you are such a consultant, or an individual who is seeking one, we will try to match you up if you email us at Consultants: send us your complete contact information, the insurance companies and plans that you represent, and whether you will make house calls or offer any public seminars before the enrollment deadline. Persons interested in insurance: provide your email, address, phone number, name of current insurance company if any, and your specific questions.   We regret that we are not equipped to handle phone calls about this; so if you don’t use email, send us your information in writing. Because we can make no guarantees that an insurance agent will call you, you should use all resources, including the APPRISE program, so that you can comply with the December 7th deadline of open enrollment.

By Dave Nesbit, Attorney