More than 540,000 Kansas residents receive health coverage through Medicare, government-funded health insurance available to nearly all citizens once they reach the age of 65. A multitude of choices are available, and all come with some kind of cost. Seniors may change plans during Medicare open enrollment, which is going on now through Dec. 7. Which plan you choose affects how much you pay each month in premiums, how much you pay in deductibles and copays, how much flexibility you have in choosing doctors and whether extras like prescription drugs, hearing aids and dental care are covered.
Nothing about choosing a Medicare plan is simple, and for that reason, free help is available from the state.
“We encourage people to always take advantage of this time, as all of us have health care needs that change over the course of a year and Medicare plans change as well,” Emily Blanch, Medicare program manager for the Kansas Department for Aging and Disability Services, said in a news release.
Most people are eligible for basic free coverage of hospitalization costs (Medicare Part A) paid for by the government. Additional government coverage for doctor visits (Medicare Part B) is optional and requires payment of a monthly premium, often deducted from Social Security checks. This premium will be $164.90 a month in 2023.
Private companies offer Medigap plans to supplement traditional Medicare A and B plans. For a flat premium, these supplemental plans pay most of the additional deductibles and copays not covered by the government for Parts A and B. Coverage for prescription drugs (Medicare Part D) is also optional and must be purchased from private companies.
As a potentially cost-saving alternative to traditional Medicare, you can enroll in Medicare Advantage plans. Nearly half of eligible Americans choose Medicare Advantage plans, which are run by private companies and subsidized by the government. This approach allows the federal government to cap its spending, leaving consumers to make up the difference.
These plans – which can offer zero or low monthly premiums and cover extras like prescription drugs, hearing aids, vision and dental – can be an attractive choice for healthy seniors. But if you require a lot of medical care, you will find your choices of doctors and hospitals limited and be responsible for costly deductibles and copays. Annual out-of-pocket costs are capped, but could run as high as $12,450 for patients using in- and out-of-network providers, plus another $7,050 cap for prescription drugs.
The Wichita Beacon offers the following Q&A to help readers find help locally and navigate these important choices.
I am currently on Medicare. What do I need to do during Medicare open enrollment?
Open enrollment between Oct. 15 and Dec. 7 is the time to review your current Medicare coverage, review materials received in the mail regarding any changes in coverage or costs of your current plan and consider whether you need to shop around for a different plan. There are several reasons to do this – all of them relate to getting the best coverage you can afford.
I am on traditional Medicare. Why would I want to switch to a Medicare Advantage plan?
You might want to switch to a Medicare Advantage plan because you are generally healthy, don’t have chronic health conditions or take many medications, want zero or low monthly premiums and/or vision, dental or hearing care, not covered under traditional Medicare.
I am on Medicare Advantage. Why would I want to switch to a traditional Medicare plan?
You might want to switch to a traditional Medicare plan if you want access to the best doctors and hospitals, or develop a chronic condition that has you paying more in deductibles, copays and out-of-pocket costs than you would with a traditional Medicare plan.
Why would I want to change my Medicare Part D prescription drug plan?
You might want to change your Medicare Part D prescription drug plan if you develop a chronic condition that requires an expensive medication and you want a lower copay. Or you might want to switch if you are paying for a more costly plan than you need because your current medications are low-cost.
What if I do nothing during Medicare open enrollment?
If you do nothing, you will keep the coverage you currently have.
Where can I get help understanding my Medicare open enrollment choices?
Trained volunteers are available through the free Senior Health Insurance Counseling for Kansas program operated by the Kansas Department for Aging and Disability Services. These volunteer counselors receive training on all health insurance subjects that concern older Kansans. They do not work for any insurance company. Call 800-860-5260 for this counseling service or click on your county in this map to find local agencies offering assistance.
In Wichita, help is available from Sedgwick County Extension Services, 316-660-0126, and Central Plains Area Agency on Aging at 855-200-2372.
Not all “help” is good help.
You may also receive postcards or see TV advertisements from private companies wanting to explain your choices. Keep in mind that most of these ads are for companies selling something who expect to profit from signing you up to their plan. AARP also cautions seniors to be wary of telemarketing scams during Medicare open enrollment.
I am not currently on Medicare. When will I be eligible?
You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. Generally, you may sign up for Medicare three months before through three months after your 65th birthday. Waiting to sign up can lead to some penalties you will pay as increased premiums. However, current exceptions apply. See this page for more info.
Who pays for all this?
Taxpayers, primarily. Part A hospital coverage – free to most people – is paid through payroll taxes. Part B doctor coverage is paid for through general federal income taxes and the premiums paid by those who enroll. In 2023, Part B premiums will be $164.90 per month. As available revenues for Medicare deplete, Congress keeps shifting more costs to the beneficiary, as through the promotions of Medicare Advantage plans that cap how much the government spends per person.
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