Finding your way through the Medicare forest

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By Evaline Auerbach

Special to the Miner

Most people are confused when they confront age 65 and eligibility for Medicare. If you are a few months away from that age, you have probably already received oodles of mail concerning the issue. You should ignore those sent by individual insurance companies until you understand the whole picture. And, by the way, it is illegal for an individual agent to contact you by phone. Tell them that and hang up!

If you have access to a computer, go to www.medicare.gov. On that site you can learn about signing up for Medicare, and finding a Medicare Advantage plan which will pay for expenses not covered in the basic premium.

Some basic principles may help you through this process :

• You are eligible for Medicare at age 65 and should apply a couple of months before your birthday. All you need is a Social Security number that indicates, by your birthdate, when you are eligible. If you don ‘t sign up for it in time, you will pay a late enrollment fee every month after you do sign up.

• Medicare premiums are basically $104.90 per month for Part B (doctors, ambulance, tests). Part A (hospitalization) is free if you have paid into Social Security. Until you are old enough to receive Social Security, you will receive a bill. However, if your income is on the low end, you may be eligible for help from Medicaid (AHCCCS in Arizona) or Medicare itself. In Pinal County, contact the Pinal-Gila Council for Senior Citizens: www.pgcsc.org or (520) 836-2758). Note: Eligibility for certain plans follows county lines so advice given for those living in Pima County may not apply to you.

• You will need a Medicare Advantage Plan or other insurance in addition to Medicare. These plans require only that you are signed up for Medicare. Your health, your prior conditions all are irrelevant.

• If you receive Veterans benefits, usually you don’t need any further insurance.

• If you are receiving medical insurance through your employer, their plan will require you to sign up for Medicare at 65 whether you are retiring or not. In most cases you will want to continue under your employers insurance plan, if eligible.

• If you work for Federal or State government, you are eligible for very good plans. They may be more expensive than private plans, but they offer more coverage than you can get with all but the most expensive private plans. Get it an keep it.

• If not covered by any of the above, you need a private Medicare Advantage plan. Do get one. You simply cannot afford, unless you are extremely lucky or very rich, to go with JUST Medicare these days. Sometimes these plans will not cost much extra: these private plans have been subsidized by Medicare to provide care based on Medicare guidelines.

• In any case, for Prescription Drug coverage, you need a private plan. Medicare itself DOES NOT cover prescriptions. You can get a “Plan C” which covers medical care and a “Plan D” which covers prescriptions, but in most cases you can get them together in one plan.

• To find the private, government subsidized, plan best suited for you,first find out which plans your best doctors accept. Then go online at the Medicare site (highly recommended- get someone to help if you don’t “do” computers). You could also find a good broker who handles multiple kinds of insurance.

• Don’t be afraid of HMOs. All the cheapest plans are HMOs. The kinks have been worked out for the most part, If you have problems, you should contact PGCSC, above.

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