Get Your Medicare Benefits – Key Choices for Seniors

For seniors, it is time again to make important choices concerning your health care benefits.

If you are a Medicare beneficiary you must become well informed to get and manage the benefits you are entitled to.

Original Medicare is the federal health care program for almost all Americans age 65 and older and for many adults with permanent disabilities. You are eligible for Medicare if you are:

• a US citizen and eligible to receive Social Security;
• or you are under 65, permanently disabled and have received Social Security disability insurance payments for at least two years;
• or you have a permanent kidney failure or need a kidney transplant; or you have Lou Gehrig's disease.

You have options of not paying the deductible and coinsurance that are part of Original Medicare by joining a Medicare Advantage Plan (MAP). However, if you don’t join a MAP, beginning January 1, 2010, under Original Medicare, the deductible for inpatient hospital care per each benefit period is $1,100 for days 1-60, not per day; then $275 per day for days 61-90; and $550 for days 91-150. For doctor visits, it is a 20% coinsurance after the $155 deductible.

Opportunity to Switch Plans
However during the Annual Enrollment Period (AEP) from November 15, until December 31th of each year you can join a Medicare Advantage Plan, or switch Medicare Advantage Plans and Medicare Part D Prescription Plans if you choose to do so. From January 1st until March 31st of each year, called the Open Enrollment Period, you can still join or switch MAPs or leave your plan and return to Original Medicare as long as you don’t add or drop drug coverage.

The IEP (Initial Enrollment Period) is still available for those who are just turning 65 and thus are aging in. If you have dual eligibility, that is, if you are entitled to Medicare Part A and Part B and are eligible for some form of Medicaid benefit, you are under the SEP (Special Election Period) which allows beneficiaries to make an enrollment change outside the regular enrollment periods. As a Dual Eligible, you can change from one Medicare Advantage-Prescription Drug Plan to another or from Original Medicare and a Prescription Drug Plan to a Medicare Advantage-Prescription Drug Plan anytime during the course of the year.

Retirement Considerations
If you are retiring, and in an employer-sponsored plan, before joining a Medicare private plan, talk to your employer or former employer to be sure you won't lose valuable retiree health benefits if you sign up with a private plan. Many employers offer retiree health coverage as a supplement to traditional Medicare. Some also offer coverage through a Medicare HMO and other private options.

Some private plans also offer a Special Needs Plan (SNP) designed to address the identified chronic needs - hypertension, high cholesterol, and diabetes of a targeted population. If you have at least one of these conditions, you are eligible to enroll in this plan during the SEP.

Contact me for a free consultation, (773)614-3201, wwillbar@gmail.com

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