Sons and daughters sometimes assist their parents with Medicare decisions. This middle-aged man said his parents, both of whom have the Oregon Health Plan (Medicaid), had been notified that they would need to enroll in prescription drug insurance as they turned 65 and became eligible for Medicare.
He made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) counselor to find a drug plan for his parents. One parent takes no prescription drugs, the man said, and the other takes several. The SHIBA counselor entered that parent’s drugs on the Medicare website and found a drug plan that would work.
However, the counselor suggested that they also take a few minutes to review Medicare Advantage insurance, which would help pay for both drug and medical costs. They found a plan that had no monthly premium and whose cost for drugs would be the same as that of the drug plan. For either Medicare Advantage or drug insurance, the website showed the cost could be reduced by two-thirds using 90-day prescriptions and the mail-order pharmacy.
Although the Oregon Health Plan now covers the parents’ medical costs, their financial circumstances suggested that they would lose OHP once the Covid public-health emergency order is lifted. The man had information about both insurance plans to take to his parents, who would make the final decision.
If you would like to make an appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
My spouse and I have marketplace insurance, really like it. Both of us will be turning 65 in a few months, would like to keep the inexpensive Obamacare insurance because we believe it would be less costly than Medicare insurance. Any reason we can’t do that?
Your questions suggests that the premium for your current insurance is subsidized because you have a limited income. That makes Affordable Care Act insurance, also known as Obamacare, attractive to millions of Americans.
But if it is inexpensive now, it may become more expensive when you turn 65 and become eligible for Medicare. That is because if your ACA insurance premium is subsidized, you will lose the subsidy when you become eligible for Medicare.
If you have a limited income you may qualify for Medicare benefits such as reduced drug costs at the pharmacy or even to have the state of Oregon pay your Medicare Part B premium of $170 a month. You could ask a SHIBA counselor or the Salem or Dallas office of Northwest Senior and Disability Services whether you qualify.
Also, among the more than two dozen Medicare Advantage insurance plans available to Marion and Polk county residents are nine that charge no monthly premium. Although Medicare could prove more expensive than your current insurance, you might instead be pleasantly surprised.
I’ve heard about Medicare fraud in the abstract but have never seen examples. And even if I knew how to spot fraud, I’d have no idea how to report it.
The estimated cost of Medicare fraud is more than $60 billion a year. It comes in many forms. Among them are billing Medicare for unnecessary services, billing for services the beneficiary didn’t receive, using higher-cost diagnostic codes for lower-cost services or colluding with a beneficiary to write an unneeded prescription for a drug that can be sold. The Centers for Medicare and Medicaid Services has an excellent one-page fact sheet that lists multiple fraud examples.
One may report fraud by calling an 800 number or by faxing, e-mailing or mailing the complaint. The phone numbers are 800-MEDICARE (800-633-4227) or 800-HHS-TIPS (800-447-8477). The first number goes to the Centers for Medicare and Medicaid Services (CMS) and the second to the Office of Inspector General in the federal Department of Health and Human Services. To learn how to report fraud by fax, online or U.S. mail, see page 20 of a CMS online report on the subject. It also describes how to report fraud by a Medicare Advantage or Prescription Drug insurance plan.
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.
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