When people retire at age 65, enrolling in Medicare is usually a no-brainer. But occasionally it’s understandable why someone might forget.

This woman lives in a nursing facility, has Medicaid, and all her medical and prescription drug needs were being met. Her 65th birthday came and went without Medicare enrollment. At 66 she realized what she’d done, and made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) counselor.

The woman’s failure to enroll in Medicare could have sparked bad results – having to wait until January to enroll in Part B and even then having a lifetime late-enrollment penalty when she did enroll. Fortunately, her low income entitled her to enroll without waiting months, it enabled her to avoid the late-enrollment penalty, and to have the State of Oregon pay her Part B premium of $170 a month.

Her story could be a reminder to seniors’ family members, and to facility administrators, to issue gentle reminders about enrolling in Medicare as an individual approaches age 65.

If you would like to make a SHIBA appointment, or to ask a question to be answered here, please see the end of this column. 

Not complaining (well, maybe a little), but this year’s increase in Part B premiums seemed really steep. Was the increase ever this much before?

You’re referring to the Medicare Part B premium of $170.10 a month, up from last year’s $148.50. It was an increase of $21.60 a month or 14.5%. 

The Kaiser Family Foundation ran the numbers going back to 2002, when the Part B premium was $54 a month. It found three times when the percentage increase exceeded this year’s: 2005 when the increase was 17.4% (from $67 to $78), 2010 when the increase was 14.6% ($96 to $111) and 2016 when the increase was 16.1%($105 to $122). 

No question, though, this year’s was the largest dollar increase during those 20 years.

In fairness, KFF found four years in which the Part B premium didn’t increase (2009, 2014, 2015 and 2018), and one in which the premium actually fell (2012, when it fell from $115 to $110).

People with Medicare have guaranteed issue for Medigap insurance when they turn 65. What other times do they have it?

Guaranteed issue means the insurance company must sell the policy, and it cannot charge a higher premium because of a pre-existing condition. A Medicare beneficiary would have guaranteed issue in 10 circumstances.

As you noted, one is when a person enrolls in Medicare at age 65. Another is when one first enrolls in Medicare Part B (people who have creditable employer insurance often delay Part B until post-65 retirement). A person who is enrolled in Medicare as a result of having had SSDI benefits will have guaranteed issue both upon first having Medicare and again upon turning 65.

To see the full list, see page 36 of the 2022 Oregon Guide to Medicare Insurance premiums.

I see on the Medicare website that Medicare Advantage plans have star ratings. I know more stars are better, but how are they assigned?

As you’ve seen, Medicare Advantage insurance plans may earn up to five stars. Prescription Drug Plans also receive star ratings.

Medicare Advantage plans’ performance is rated on five measures: how good a job the insurance does in keeping the person healthy with screenings, tests, vaccines and such; how well it manages chronic or long-term conditions; the plans’ responsiveness and care; the number of member complaints, problems enrollees have in obtaining services and the share of enrollees leaving the plan; and the insurance plan’s customer service.

Prescription Drug Plans, meanwhile, are rated on four measures: customer service; drug price and patient safety; member experience; and member complaints, problems obtaining services, and the share who choose to leave the plan. 

For more detail about this see the explanation on the Medicare Interactive website. 

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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