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COLUMN: There are ways to cut premium costs for Medicare plans, but assess tradeoffs

He was a relatively low-income Medicare beneficiary with a fairly expensive Medicare Advantage insurance plan. He was paying a $75 a month for his insurance, and he wanted to know if he could find a plan that would cost him less and still serve his needs.

The Medicare counselor with whom he spoke said the same company had a $19-a-month plan that would have higher co-pays while saving him $56 a month in premiums.

The less-expensive insurance would have a higher annual maximum out-of-pocket expense ($6,200 vs. $5,700) if he incurred major medical costs. Its drug deductible – what he would pay at the pharmacy before the insurance started helping – would be $250 instead of $150.

Beyond that, many of the higher costs amounted to $5 or $10 for such things as doctor visits or daily hospital costs. It was a matter of whether he thought he could prepare for the higher expenses with the lower-cost plan. The Medicare counselor sent him details about both plans to compare.

If you would like to get such help, make an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) counselor, or ask a question to be answered here, please see the end of this column.

During open enrollment I chose a Medicare Advantage plan. Now that open enrollment has ended I’ve learned about one I would prefer. I’m stuck for the next year, right?

Not necessarily – Medicare may have a holiday gift for you. If a Medicare beneficiary is unhappy with a Medicare Advantage plan she may enroll in a different plan from Jan. 1 through March 31. The new coverage would begin the first of the month following the new enrollment.

A bit more information about Medicare’s rules: An individual could also switch to Medicare only or switch to Medicare only and enroll in a prescription drug plan during the January-March period. However, Medicare rules prohibit switching from one prescription drug plan to another during this period.

On Medicare.gov I’ve noticed that some Medicare Advantage plans don’t cover prescription drugs. Why would someone want a plan that doesn’t cover drugs?

There are two primary reasons for this. One is that a Medicare beneficiary may have drug coverage through the Veterans Administration and therefore not need other drug coverage.

The other is that some Medicare beneficiaries might face a hefty late-enrollment penalty because for years they had no drug coverage that Medicare defines as acceptable. As a result, enrolling in prescription drug insurance would trigger the lifetime penalty, so they continue to forgo the drug insurance.

Social Security tells me because I don’t have 40 work quarters (I have 38) that I will have to pay a premium for Medicare Part A. The premium is more than $200 a month. Is there any way around it?

This is a subject worth taking up with Social Security. If your spouse worked 40 quarters (10 years), for example, you may qualify for premium-free Medicare Part A.

You might also earn you way to premium-free Part A by working those two additional quarters. You might be surprised by how little you would have to earn: The Social Security website says in 2021 one must earn at least $1,470 for a quarter to be counted.

To talk with Social Security, call the national phone number at 800-772-1213. Or reach the Salem Social Security office at 866-593-1559.

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.