She was about to turn 65, wanted to learn more about Medicare insurance and wanted coverage for visits to a naturopath.
She made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor, who walked her through her insurance options.
But the woman’s desire to see naturopathic doctors was a complication because Medicare doesn’t cover naturopathy. As a result, no Medigap supplemental insurance would cover it. And most Medicare Advantage insurance plans don’t.
However, the counselor found several Medicare Advantage plans that would cover some naturopathic services. Checking with several of the companies, the counselor provided coverage details.
The most attractive insurance plan for this person was one that charged no monthly premium and would cover visits up to $500 for its share (the insured would have a $40 office co-pay for each visit). The woman’s doctor was in the insurance company’s network, and the insurance would cover her drugs.
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.
Q: I’ve been seeing advertising for Medicare insurance that pays for dental, vision, hearing and gym memberships. If this is for real, how do I find this insurance?
Yes, some Medicare Advantage plans do cover some of these costs some of the time. It’s up to you to ask the company about what it will cover. Ask them to mail you printed information or to refer you to specifics on the company website.
For example, some Medicare Advantage insurance will pay for semi-monthly dental cleanings and for dental exams. Some will pay part of the cost of hearing aids. And even some zero-premium Medicare Advantage insurance will pay for a fitness membership.
But some claims can be misleading, so it’s up to you to get detailed information.
You may look for Medicare Advantage insurance by logging on to Medicare.gov. When you see that the plan offers “some coverage” for dental, for example, that’s when you contact the insurance company for details. To find the company’s phone number and website, scroll to the end of the page on Medicare.gov.
Q: When I turned 65 in August I enrolled in a Medicare Advantage plan. I was getting a lot of insurance mailers, and didn’t know about Medigap supplemental insurance. Now I wish I had that instead. Do I have options?
Yes. Because you are in the first year of Medicare and Medicare Advantage insurance, you will have guaranteed issue for a Medigap supplemental policy. That means the Medigap company cannot charge you more because of a pre-existing condition. This rule applies to people like you who enrolled in Medicare Advantage insurance when they first had Medicare and want to leave the plan within the first 12 months.
Q: I’m 75, and I would like to see what Medigap supplemental insurance would cost me. I’m in pretty good health, but expect my age would influence the premium. What would a supplemental policy cost me?
A 75-year-old Salem resident who doesn’t use tobacco could expect to pay about $158 a month for a Plan G policy. The next lowest-cost Plan G policy would be $198 a month. Or you could enroll in a plan with somewhat lesser coverage, such as Plan N, for about $136 a month.
These premiums assume that the insurance company is willing to insure you, and that the company doesn’t raise the premium because of a pre-existing condition it doesn’t like. People who have Medigap insurance should enroll in separate, stand-alone insurance for prescription drugs, too.
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.
