It’s that time of the year again. No, I’m not talking about football season, nor the World Series. I’m referring to the Medicare open enrollment period (October 15- December 7), the time where individuals can change their prescription or health coverage. And, just like the NFL and NBA Draft, Medicare enrollment can be just as confusing! I am absolutely convinced that you need a PhD in governmental bureaucracy to decipher the hieroglyphics on the paperwork and I am someone who is actively involved in healthcare on a daily basis. Therefore, if I struggle to understand it, how do we expect some sweet, mildly demented 80-year-old grandmother to figure it out?
Individuals who turn 65 and are receiving Social Security or Railroad Retirement Board benefits will be automatically enrolled in Medicare Part A and B. This group will get their red, white and blue card 3 months prior to turning age 65. The complication of this process occurs when individuals are not receiving those benefits (example: a 65-year-old who is still working) and must sign up for Medicare during the Initial Enrollment Period.
When participants are first eligible for Medicare, they have a seven month Initial Enrollment Period to sign up for Part A and/or Part B. Depending on when the participant signs up will determine coverage start dates. Per Medicare.gov, not enrolling in Medicare Part B when you are eligible could result in a late enrollment penalty for the duration of Part B coverage in addition to a gap in coverage.
There are also circumstances that qualify for a Special Enrollment Period, such as a change of address, eligibility for Medicaid, or if the participant is receiving services in an institution like a skilled nursing facility.
The two principle ways to utilize Medicare is original Medicare, Part A/B, and the Medicare HMO plans. Part A is hospital coverage and Part B is the medical insurance, which covers doctor visits and other medical services. Part C is the advantage plan offered by private insurance plans and often times cover medications. In 2003, President George W. Bush established Medicare Part D, a program to help cover prescription costs as well. Most medical providers accept Medicare, but many physicians are choosing to abandon traditional fee-for-service work and transition to concierge practices.
Many people mistakenly believe that Medicare will cover all healthcare costs. However, vision and dental expenses are services not covered and depending on the type of plan you have, certain copays may be required at the time of service. In addition, medical devices, such as hearing aids may also not be covered and can be as expensive as several thousand dollars.
Once your Medicare is effective, I recommend that you schedule your “Welcome to Medicare” physical with your primary care doctor. This visit is comprehensive and addresses issues, such as living wills, immunizations, and preventative services such as mammogram, colonoscopy, and bone density.
This yearly visit gives your doctor an opportunity to also assess your ability to perform day-to-day tasks, such as making meals, cleaning home and bathing self. Some patients at this visit need mental health evaluations to determine early stages of dementia and whether or not they are safe to live independently. Other areas of concern addressed include senior safety as it relates to poly-pharmacy. Seniors aged 60-65 on average take 14 prescriptions per year.
If I had to list an area where Medicare recipients could use a little more assistance is understanding the importance of that living will. Family members need a clear, concise message about the wishes of their loved ones long before they are unable to speak for themselves. Basic questions like, “Do they want CPR in the event their heart stops?”; “Do they want a tube placed down their throat to help them breathe?” or “Do they want to be given electrical shocks to revive their heart?” need to be asked and the answers documented so that the family and healthcare providers are on one accord.
Growing older is difficult enough and carries more than its fair share of ups-and-downs without adding to it the burden of confusion regarding health insurance. AARP and Medicare.gov are excellent resources to aid future and current Medicare participants to better comprehend their benefits or lack thereof.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
