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Wednesday, February 20 , 2019, 6:05 am | Fair 38º

 
 
 
Your Health

Karen Telleen-Lawton: Too Late for Medicare Do-Over?

[One in a continuing series.]

Examining your finances takes fortitude. What are your goals and dreams? What can you afford? Here is another question modified from my financial advisory practice.

Dear Karen: I turned 65 last year and joined Medicare. I was really busy at the time, so I just signed up for the same program as a friend of mine. Now I wish I’d given it more thought. Is it too late to change?

— Wants a Do-Over

Dear Do-Over: With Medicare (and the Affordable Care Act), you get a do-over every year! And right now (Oct. 5 through Dec. 7) is the open enrollment period, so it’s time to get cracking.

As you probably discovered already, Medicare isn’t a get-out-of-jail-free card for all your medical expenses. Medicare for Dummies calls it “your passport into the terrain of guaranteed health care, where you’re welcome regardless of income or pre-existing medical conditions, but you still have to find your way around.” Before Medicare (pre-1966), most seniors were denied medical insurance coverage because of their age.

Your first decision is Medicare (A and B, plus perhaps D or Medigap or both) versus Medicare Advantage. Some procedures aren’t covered under Medicare at all: routine hearing, vision, dental, and foot care; home safety items, nursing home care (long term care) and medical services abroad. There is no annual limit on the amount of costs you may have to cover in a year of Medicare.

Medicare Advantage is the alternative Part C program, with HMO- and PPO-type coverage administered by private companies. MA must cover at a minimum what Parts A and B cover, but add a variety of drug and other coverage. MA plans are required to set a limit on your annual out-of-pocket costs. The limit is $6,500, though some plans set much lower limits, like $3,000 or less.

Begin by examining your out-of-pocket costs and your prescriptions over the past year. Then go to the plan finder online (www.Medicare.gov/find-a-plan), enter your ZIP code and some other information, and find the best plan in your area for your needs. It helps to make a chart for the ones that look best, comparing the monthly premium, annual deductibles, co-payments and less quantifiable factors such as whether it covers the services you are likely to need, whether you would need to change doctors, etc.

You’ll find great variation particularly in Part D coverage. An AARP Bulletin analysis of 31 plans in California showed a certain insulin drug will cost between $24 and $170 for a 30-day supply in 2015, with 14 plans charging under $4 a month and eight plans charging over $80. Monthly premiums for Part D range from $12.60 to $171.90 with a national average of $38.83.

Medicare Advantage plans will receive somewhat lower government payments in 2015, under Affordable Care Act rules. While it was unusual for MA plans to charge annual deductibles in the past, some are starting to. It’s unclear how these changes will affect Medicare Advantage in the long term, but for now they remain a robust choice.

It’s a good idea to review your coverage every year, especially in these years when medical insurance is changing rapidly. In your first year under the program, there is even more latitude for changing you mind.

A fee-only financial advisor to help in the search. Or you can get personal assistance from a counselor through the State Health Insurance Assistance Program (SHIP). For California, it is the HICAP Department of Aging, available at 800.434.0222.

If you do nothing, your coverage will remain the same. But now you know it pays to shop!

— Karen Telleen-Lawton’s column is a mélange of observations spanning sustainability from the environment to finance, economics and justice issues. She is a fee-only financial advisor (www.DecisivePath.com) and a freelance writer (www.CanyonVoices.com). Click here to read previous columns. The opinions expressed are her own.

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