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Making sense of Medicare

Volunteer Bob Hill helps seniors sign up for federal health insurance program

Posted: December 13, 2009 10:08 p.m.
Updated: December 14, 2009 4:55 a.m.

Volunteer Bob Hill discusses Medicare options with seniors at the Santa Clarita Valley Senior Center on Wednesday. Hill goes to the center three times a month to assist seniors with the application process.

 

Turning 65 does have its advantages.

That's the milestone when seniors can apply for Medicare, the federal health insurance program that covers most U.S. residents 65 and older, as well as those who have received Social Security disability for at least 24 months, have amyotrophic lateral sclerosis , also known as Lou Gehrig's disease, or have end-stage renal disease.

"When you become 65, you are automatically eligible for Medicare if you paid Social Security tax during your employment," said Bob Hill, volunteer at the Santa Clarita Valley Senior Center. "Disabled people can enroll earlier."

Hill, a trained Health Insurance and Counseling Program volunteer, is available three Mondays a month and by appointment to help Santa Clarita Valley seniors sort through the sometimes confusing Medicare paperwork and application process.

Stationed at the supportive services department at the Newhall center, Hill, a former technical sales manager who retired in 1995, estimated he's helped 100 to 150 people annually over the last seven years get their Medicare benefits.

"It's really rewarding, this opportunity to help people. When I retired, I had COBRA insurance and didn't know I could apply for Part B. A non-profit agency really helped me out a lot. I consider this payback for what they did," Hill said. "I found out what my clients need, if they are having any problems, and answer questions."

Medicare's Annual Coordinated Election Period (AEP) runs from Nov. 15 - Dec. 31, during which time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare or enroll in a Medicare Advantage Plan for the first time. Enrollment changes take effect on Jan. 1, 2010. Potential beneficiaries must be 65 at the time of application.

Broken down into several categories, beneficiaries can apply for a series of Medicare Benefits. Part A typically refers to hospitalization expenses and the monthly premium is paid by the government.

"Changes are made every year. This year, the benefit period starts the first day you go to a hospital and ends when you are out of the hospital or have not received skilled nursing care for sixty consecutive days," said Anita Chun, community education coordinator at Center for Health Care Rights. "Part A covers your hospital costs completely, except for the admittance day, which is capped at $1,100. Then Medicare will pay for days 1 to 60. For days 61 to 90, the beneficiary pays $275 per day."

Part B refers to outpatient medical expenses, such as doctor's visits and laboratory work, which costs $96.40 per month for California residents and is deducted directly from the recipient's Social Security check. Medicare pays for 80 percent of these expenses. The remaining 20 percent is incurred by the beneficiary.

"More than likely, if you have employer group health insurance as part of your retirement or if you are still employed, you should not enroll in Plan B. That's what costs," Hill said. "Part A is free in the sense that by paying taxes over the years, you have paid for the coverage."

Applicable applicants are encouraged to keep any existing medical insurance coverage or purchase a supplemental policy termed "Medi-Gap," which is available through traditional insurance companies and organizations such as American Association of Retired People, to provide 100 percent coverage and avoid excessive medical costs.

"That 20 percent adds up fast," said Sue Slay, assessor and care manager at the center. "When you're in the hospital, there are doctor fees, anesthesiologists and all sorts of supplemental charges. For some seniors, that means, do I eat or pay the bills? Believe it or not, it's a challenge for a lot of seniors in the Santa Clarita Valley who are on tight budgets."

Medicare's Part B pays its share of beneficiary charges directly to medical offices, laboratories and physicians. The remaining percentage is billed to the client from its point of origin.

While most doctors in California accept Medicare, Hill advised to confirm with the medical office when making the initial appointment as some don't, while others may charge an increased percentage to the patient to make up for the negotiated fee Medicare pays to them.

The General Enrollment Period (GEP) for beneficiaries who did not apply for Part B when they first became eligible for Medicare may elect Part B coverage from Jan. 1 through Mar. 31 each year. Enrollment becomes effective on July 1 of the same year.

"Otherwise you could end up paying up to 35 percent of the outpatient expenses or worse - get stuck with the whole bill," Hill said.

Part C of Medicare refers to managed care such as HMOs, while Plan D offers beneficiaries the opportunity to purchase prescription drug coverage for $7.50 to $35 per month, with Medicare covering 75 percent of prescription charges.

Since seniors turn 65 every day, Medicare is flexible on applying for initial benefits, as is Hill.

He'll make appointments outside of the first, second and fourth Mondays he's at the senior center. He also offers house calls to those unable to make it to the Newhall location. Hill allows an hour for the application process and is willing to stay later if it goes longer.

Hill's assistance to seniors in the community is vital, according to Slay.

"I hear so many times from families, ‘Oh, Mom's OK now, she's got Medicare.' They think it's all-inclusive insurance, but it's not," Slay said. "It's important to understand all the Medicare pieces."

For more information on Medicare enrollment at the Santa Clarita Valley Senior Center, call (661) 259-9444 and ask for Bob Hill.

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