COLUMN: Enrollment open through Dec. 7 for Medicare Advantage, prescription drug coverage

Sometimes delving into Medicare questions produces good results. The 68-year-old Medicare beneficiary had recently moved to Oregon and wanted help finding new Medicare insurance. He made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) counselor.

As the man described the no-premium Medicare insurance he had in another state, it sounded even better than what he might find here. The SHIBA counselor first asked an income question, finding that his income was low enough to have his $148.50-a-month Medicare Part B premium paid. (The premium is expected to be higher in 2022.)

The counselor then described the two types of insurance – Medicare Advantage and Medigap supplemental – providing premiums and benefits for both. The man became intrigued with Medigap supplemental, realizing that with the savings from not having to pay the Medicare Part B premium he could afford this higher level of insurance.

Because he had recently lost his Medicare insurance because of the move, he qualified to buy a Medigap policy with no questions asked about his health status. It’s unknown what he finally did, but when he left he was seriously considering the option.

If you would like to make a SHIBA appointment, or to ask a question to be answered here, please see the end of this column. 

Last year I was unable to get a SHIBA appointment, so this year I scheduled one early. But what if someone cannot get a SHIBA appointment – there must be alternatives, yes?

Yes. Open enrollment for Medicare Advantage insurance and for prescription drug insurance runs through Dec. 7. These are alternatives to SHIBA appointments:

-Go online to Medicare.gov. Below Find a 2022 Medicare plan, click on Log in or Create Account OR click on Continue without logging in to review 2022 Medicare Advantage plans or Prescription Drug Plans. Note: If you are new to Medicare and instead want to review 2021 plans, then after you get into the site click on Show me 2021 plans at the top of the page.

-Call Medicare at 800-MEDICARE (800-633-4227). This is a 24/7 service.

-Call the SHIBA helpline at 800-722-4134 during normal weekday business hours. Don’t enter your ZIP Code, just stay on the line. If calls are backed up, your call may be transferred to the Medicare hotline (see above) with its “Welcome to Medicare” getting. 

-Speak with a state-certified insurance broker. Scroll down the page and enter your information including selecting Medicare Agents. You are not limited to agents in the county where you live. 

My Medicare will start in January. Will I be able to get a full physical exam like I do every year while I’m working?

Medicare calls it a wellness visit, and the specs are different from a full physical exam. This is explained on page 17 of the 2022 Oregon Guide to Medicare Insurance Plans. You are entitled to an initial Welcome to Medicare visit, which will include screenings, shots and care referrals if needed; getting your height, weight, blood pressure and body mass; giving you a simple vision test and reviewing your risk for depression; an offer to talk about creating an advance directive; and a written plan for future screenings, shots and preventive services.

After that you may schedule annual wellness visits, which, albeit helpful, are normally less comprehensive than a full physical exam. Detail about the Welcome to Medicare visit is available on the Medicare website, and from that page you may click on Yearly wellness visits.  These services are provided at no cost to you unless the visit goes outside the bounds of the Medicare-approved regimen. 

I don’t take any prescription drugs, but want to get insurance to avoid the Medicare penalty for not having it. What’s the range of prices?

For Medicare beneficiaries in Marion and Polk counties, 2021 monthly premiums for prescription-drug coverage range from $6.30 to more than $100. For 2022, monthly premiums start at $7.70.

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected] To schedule a free SHIBA phone appointment with a volunteer Medicare counselor, call 800-722-4134.