By Anne Marie Amacher
The Catholic Messenger
Enrollment into all parts of Medicare is not automatic; there are eligibility periods. Seniors also need to think about options concerning secondary health insurance and prescription plans for Medicare.
Mike Stahler, President of Stahler and Associates in Davenport and a member of Our Lady of Lourdes Parish in Bettendorf, has been involved in the health care industry in various capacities for decades. From working as a nurse to doing administration work in the health care industry to selling supplemental and prescription plans, Stahler has learned many things seniors need to be aware of.
First, individuals turning 65 years old have a seven-month period to sign up. It starts three months before the month of your 65th birthday and ends three months after. Sign up during that period to avoid becoming ineligible.
Medicare has four parts: hospital insurance — Part A; medical insurance, such as doctor and health care provider coverage — Part B; Medicare Advantage plans (receive all you health services through one provider if you choose) — Part C; and prescription drug coverage — Part D.
Stahler said Parts A and B generally cover 80 percent of costs. Part A is automatic and free, but Part B can have premiums, depending on income and other factors.
While that coverage may be fine for some, others may choose to buy a supplemental health insurance plan to cover the other 20 percent. A variety of plans are available. Stahler said seniors are often bombarded with mailings and other offers about supplemental insurance.
Part D covers prescriptions. Prescriptions while hospitalized are covered under Plan A. Otherwise no prescriptions are covered under A and B.
For supplemental and prescription plans, the best thing to do is meet with a Medicare- certified insurance agent. “We certify and recertify and are tested” to be able to offer Medicare plans, Stahler said.
For those who want to roll the four parts of Medicare into one plan, there is Part C, Medicare Advantage. Meeting with a specialist to do this is important.
For Part D, the agent plugs in a person’s current prescriptions on a computer to determine the best prescription plan. Other supplemental plans can be offered to meet the senior’s needs.
Stahler said subsidies for both may be available for some people. Depending on the type of plan selected, income and other variables, some people might pay premiums while others might not.
Once signed up, seniors cannot change plans until open enrollment, which is Oct. 15 to Dec. 7 each year. Changes take effect Jan. 1 of the following year. There are some exceptions he noted, such as moving to an area where that individual’s plan is not covered. In that case, a person would be eligible to change his/her plan.
For those in Part C, Medicare Advantage “disenrollment” period is Jan. 1-Feb. 14. Disenrollment refers to leaving the Advantage Plan for traditional Medicare.
Rule changes are ongoing with Medicare, Stahler said. So it is important to work with a certified insurance agent.