It isn’t often that one can make $25 a minute, but it appears this Medicare beneficiary did. He has Medigap supplemental insurance for medical and a separate insurance plan for prescription drugs. During recent open enrollment he made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) counselor to see if he could save any money.
He could. First, he could save $500 or more in 2022 by changing to another insurance plan for drugs, which he did. But it gets better: The SHIBA counselor reviewed Medigap premiums to see how the Medicare beneficiary’s monthly premium compared with those of other companies’ policies.
To use Oregon’s birthday rule, the beneficiary will have to wait several months to change Medigap plans (autumn open enrollment is only for Medicare Advantage and drug insurance). But if the current spread between premiums holds, he stands to save another $1,200 a year. His time investment: About 60 minutes.
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.
We’re seriously considering a cruise this year. If we get sick or have a health emergency, what will Medicare pay?
Cruise ships sail under foreign flags and you are outside the United States. If you have Medicare only, called Original Medicare, you will almost always be responsible for the entire bill. It’s a good idea to investigate travel insurance.
But let’s assume that you have insurance in addition to Medicare. If you have Medicare Advantage insurance, it may help pay for a medical emergency on the high seas or in a foreign country. It’s best to check with your insurance company, though, and ask to be shown the benefit on the company’s website or to have details sent to you.
If you have Medicare supplemental (Medigap) insurance, it may help for medically necessary emergency care. The policies that will pay are Plans C, D, F, G, M and N, and Plan F High Deductible and G High Deductible. After the insured pays a deductible, those plans pay 80 percent of care that Medicare would have covered had the health care been delivered in the U.S., although only if the emergency begins during the first 60 days of travel.
You can read about this on page 35 of the 2022 Oregon Guide to Medicare Insurance Plans and see full detail about Medicare coverage outside of the U.S. on the Medicare website.
I have straight Medicare, no additional insurance. Mostly, I don’t have insurance because I’m in good health and don’t want to pay a premium for services I don’t use. Am I making the right choice?
Because you are averse to paying insurance premiums, consider the pluses and minuses of Medicare Advantage insurance. Nine such plans available to Marion and Polk county residents have no premium. If your health took a turn for the worse, with this insurance your maximum annual out-of-pocket expense for medical would range from $4,500 to $7,500 depending on the plan you chose. Original Medicare, which you have, has no out-of-pocket spending limit for medical.
With all but one of these no-premium insurance plans, you would have no office co-pay to see your primary care physician; with Medicare only, you pay 20 percent of the bill. Medicare Advantage plans specify what you would pay for a given service such as hospitalization, ambulance, an ER visit, and diagnostic and lab tests, for example.
Original Medicare also has benefits, though. You can see any physician you want so long as the doctor accepts Medicare and is accepting new patients. You don’t need referrals to see a specialist. With Medicare Advantage insurance you could see doctors within the insurance company’s network (and in some instances outside the network for a higher co-pay).
You didn’t mention insurance for prescription drugs. Most Medicare Advantage insurance includes drug coverage. Even if you choose not to enroll in Medicare Advantage insurance, having insurance for prescription drugs will ensure you don’t face a lifetime late-enrollment penalty later.
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.
STORY TIP OR IDEA? Send an email to Salem Reporter’s news team: [email protected].
JUST THE FACTS, FOR SALEM – We report on your community with care and depth, fairness and accuracy. Get local news that matters to you. Subscribe to Salem Reporter starting at $5 a month. Click I want to subscribe!
