The Medi Maze: Medicare, Medigap, and Medicaid

You don’t have to be an aging parent to find yourself untangling the mystery of the three medi’s. Anyone approaching the 60’s age bracket will want to take the time to understand the ever changing world of insurance for seniors.

We appreciated Denise Musselman, Apprise Program Coordinator in the Lehigh County Office of Aging and Adult Services, taking the time to guide us through the maze of Medicare, Medigap, and Medicaid.

A great first place to begin is the booklet Medicare & You 2011. You can order a printed copy by calling 1-800-633-4227 (1-800-MEDICARE).

Social Security

My personal experience was that if you sign up for Social Security benefits at 62, you are “in the system” and a packet of information will be sent to you prior to your 65th birthday. From personal experience, as you approach 65, you receive a lot of mail on Medicare and the many insurance options and much of it is junk mail and confusing. However, be sure to take note of anything and everything from CMS. This is the Centers for Medicare and Medicaid Services and will contain mportant information for you.

The following Medicare information is complied and summarized from what Denise shared and the various links referenced throughout. Please refer to these links for complete information.

Medicare

Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are entitled. There can be serious implication for individuals who fail to enroll in Medicare during their proper enrollment period that will increase the costs when they do enroll. So, this is a subject to study and make decisions on at the right time.

There are various components to Medicare as follows.

Part A is for all those 65 and older. There is a 7 month window to enroll: 3 months before, the month of, and 3 months following your 65th birthday. This is free for most people. It pays inpatient hospital care, hospice care, inpatient care in a skilled nursing facility, and home health care services.

Part B individuals receiving Social Security retirement benefits, individuals receiving Social Security disability benefits for 24 months, and individuals otherwise entitled to Medicare Part A, are automatically enrolled in Part B unless they decline coverage. This covers medical care and services provided by doctors and other medical practitioners, home health care, durable medical equipment, and some outpatient care and home health services. Most people have to pay a monthly premium (presently about $96.40/mo) for Part B and it is basically medical insurance provided by the federal government.

Part C called Medicare Advantage has several choices: HMO, PPO, Private Fee-for-Service Plans. The surprising part is that it is provided through private insurance companies approved by Medicare and costs about $80-$100/mo. Most offer a prescription plan.

Part D is Prescription Drug coverage and are all run thru private plans. This significant piece of info on this is that if you do not sign up at the time you qualify, you will be heavily penalized if you choose to sign up later. She said to look at it like Car Insurance, you pay for it but hope you never need to use it but you are glad you have it when you do need it.

Review and enrollment can be done during open enrollment between November 15 and December 31 each year. Denise recommends that each person review their medicare plan yearly. Their office provides a service called RSVP. Retirement Senior Volunteer Program sites are listed at this link along with the phone number to call to make an appointment to discuss with someone your Medicare options.

Much of this information came from a link at http://www.lehighcounty.org/ that is no longer working.

Additional links on Medicare include:

• http://www.medicareconsumerguide.com/ provides a quick overview of Medicare with links to more detailed explanations of each part.
• Medicare and Medicaid: What’s the Difference?
• http://www.medicareadvocacy.org/default.htm

Medigap

Medigap is Medicare Supplement Insurance and does just that, provides supplemental health insurance coverage for Medicare beneficiaries. Medicare pays 80%. If you purchase Medigap, it pays the remaining 20%. Denise mentioned the list of insurance companies in Pennsylvania that offer this insurance. They all offer the same help but prices differ. The state also has an online brochure as a PDF.

This link had good details http://www.medicareadvocacy.org/faq_medigap.htm

Medicaid

Although Denise did not discuss Medicaid, the following sites offer some general information on this subject and serve as excellent starting places.

• The 3 Medi’s: Medicare, Medigap and Medicaid (see page 18 in the booklet)
• What is Medicare / Medicaid?

Government web sites offer additional information on this topic:

• Medicare and Medicaid: http://www.cms.hhs.gov/
• Medicare: http://www.medicare.gov/
• Medigap http://www.medicare.gov/medigap/Default.asp

Once again, we appreciate Denise’s help with this. As of 2009, she coordinates the Apprise Program. If you would like additional assistance figuring all this out, call 610-782-3200 for referral to the local APPRISE office for an appointment to review Medicare options for you or your parents.

If your parents do not live in Lehigh County or in Pennsylvania, these same services are available all over the country through a similar county office. Check out the state and county your folks live in for information and contact information.

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