Pixel Tracker

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.

Talk to Us!

Please take Noozhawk's audience survey to help us understand what you expect — and want — from us. It'll take you just a few minutes. Thank you!

Get Started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made using a credit card, Apple Pay or Google Pay, or click here for information on recurring credit-card payments and a mailing address for checks.

Thank you for your vital support.

Become a Noozhawk Supporter

First name
Last name
Select your monthly membership
Or choose an annual membership

Payment Information

Membership Subscription

You are enrolling in . Thank you for joining the Hawks Club.

Payment Method

Pay by Credit Card:

Mastercard, Visa, American Express, Discover
One click only, please!

Pay with Apple Pay or Google Pay:

Noozhawk partners with Stripe to provide secure invoicing and payments processing.
You may cancel your membership at any time by sending an email to .(JavaScript must be enabled to view this email address).

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click Here to Get Started >

Reader Comments

Noozhawk is no longer accepting reader comments on our articles. Click here for the announcement. Readers are instead invited to submit letters to the editor by emailing them to [email protected]. Please provide your full name and community, as well as contact information for verification purposes only.


Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series