She was asking a fairly common question. “I’m about to turn 65 and have good insurance through my employer,” she said. “I plan to work another year or two. Does Medicare require me to do anything now?”
She met with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor to get the answer.
She was told that, assuming Medicare defines her employer insurance as creditable, she could delay Medicare Part B and its $148.50 monthly premium.
It’s a good idea to check with human resources, though, to ensure that the employer insurance is creditable for both medical and Rx drugs.
Although failure to enroll in premium-free Medicare Part A carries no penalty, she learned, enrolling would make it a bit easier later to enroll in Part B.
To enroll in Part B later she would need to complete CMS forms 40B and L564, both of which are available on the Social Security website (ssa.gov) or by asking Social Security to mail them.
If you would like to make a phone appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
Q: Enrolling in Medicare Advantage insurance with no monthly premium is appealing. Do these plans offer pretty much the same benefits?
Although none charges a monthly premium, there may be other significant differences. Consider terms of five zero-premium plans available to Marion and Polk county residents from Aetna, Health Net, Kaiser Permanente, Providence and United Health Care.
With four of the plans you would have no office co-pay to see your physician, and with one you would pay $5. To see a specialist, co-pays range from $35 to $45 per visit. Those differences among policies seem relatively small.
You encounter a bigger difference when looking at the maximum out-of-pocket medical expense for which you could be responsible during the year, which ranges from $5,500 to $7,000.
The drug deductible – that is, what you pay at the pharmacy before insurance starts helping – ranges from zero to $150. Likewise, for outpatient hospitalization, you would pay up to $275 to $400. One plan has the insured pay 20 percent of the cost, which could be a bargain or wildly expensive depending on the cost of the medical procedure.
If someone were to spend 100 days in a skilled nursing facility because of an injury or illness, the patient’s cost could range from as little as $5,704 to as much as $14,720 depending on the insurance plan. The difference results from the number of days the insurance company pays all of the bill, which ranges from 20 to 69.
When comparing plans and making a decision, it’s useful to set up a grid so you can compare the costs most important to you. You can compare plans on Medicare.gov, or a SHIBA counselor could assist.
Q: The other evening, friends were telling us about their Medigap supplemental insurance and said they get a household discount. What is that?
The discount is offered when two people from the same household enroll in the same type of Medigap insurance policy. The two people need not be married, but must live together. They could be siblings, roommates, partners, even parent and child. A household discount is available only for Medigap supplemental insurance, not for Medicare Advantage insurance plans.
Q: Sometimes I just have a single question about my Medicare, nothing worth making an appointment. Is there somewhere I could call?
You can call the SHIBA helpline at 800-722-4134. You will hear a request to enter your ZIP Code; don’t do it, just stay on the line. The line is staffed during weekday business hours. Questions are answered by knowledgeable Medicare professionals with the Oregon Department of Consumer and Business Affairs.
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.
