Approximately 11,000 adults become eligible for Medicare every day, reflecting a dramatically increasing senior population, and that number is only going to grow. The U.S. Census Bureau predicts there will be nearly 47 million seniors age 65 and up in 2015 and about 72.1 million seniors – nearly 20 percent of the population – by 2030.[i], [ii]
Here in Texas, the 65 and older population is expected to increase from 11.7 percent of the overall population in 2014 to 15.6 percent of the overall population by 2030.[iii]
Health concerns are a major issue for seniors, with nine of 10 older adults living with at least one chronic condition, such as diabetes, arthritis, hypertension or lung disease, according to the National Council on Aging.[iv] Making matters worse, these conditions place a significant financial burden on seniors and, sometimes, their caregivers. As a result, there’s a clear need for access to affordable health care that meets the needs of individuals as they age.
As San Antonio residents approach their 65th birthday, it is important for them to know their Medicare options, including when they can enroll and the types of health plans available.
Seniors should keep an eye out for materials from the Centers for Medicare & Medicaid Services in the months leading up to their 65th birthday. In the meantime, it can’t hurt to pull information together to prepare. Following are tips to help seniors and their caregivers as they begin the Medicare plan selection process:
Know Your Options. You will want to find a plan that provides the health care coverage you need and maximizes your health care dollars. In general, your options include:
- Original Medicare (Parts A and B) is a federal insurance program that offers basic coverage for hospital care and medical expenses and no coverage for prescriptions. Beneficiaries typically must pay a premium for Part B coverage. Many find they need additional coverage for services not covered by Original Medicare.
- Medicare Supplement plans pay some of the costs that Original Medicare doesn’t cover, including deductibles and coinsurance. Beneficiaries must pay an additional premium.
- A Medicare Prescription Drug Plan (PDP), or Medicare Part D, provides prescription drug coverage, helps lower prescription drug expenses and protects against higher costs in the future. Beneficiaries must pay an additional premium.
- Medicare Advantage (Part C) typically provides extra benefits, services and often prescription drug coverage. Beneficiaries may or may not pay an additional premium.
Know Your Medicare Advantage and Prescription Drug Plan Enrollment Timeframe. This year, during the Annual Election Period (AEP) from Oct. 15 to Dec. 7, seniors who are eligible for Medicare can review Medicare Advantage and Medicare Part D plan options and select health care coverage for 2015. However, people turning 65 before October can enroll earlier in the year. In fact, they have a seven-month window – known as the Initial Enrollment Period (IEP) – to enroll. This includes the three months before their 65th birthday, the month of their birthday and the three following months. If a 64-year-old enrolls in the first three months of their IEP, their benefits kick in on the first day of the month of their birthday.[v] If they enroll during the remainder of their IEP, their benefits will be effective on the first day of the following month.
Know Your Medical Cost History. Review your records to see how much you spent on health care during the past year. This should include hospital expenses, pharmacy costs and doctor bills. Then, determine if the previous year was typical, and try to calculate your best estimate for health care costs in the year ahead.
Know Your Resources. If you are considering a Medicare Advantage plan, research the costs, benefits and network of doctors and hospitals associated with each plan. Take advantage of resources available to help you with the research to make an informed choice. The government’s Medicare website, www.medicare.gov, is a good resource that lets you find and compare Medicare health and prescription drug plans in your area. The Centers for Medicare & Medicaid Services make it easier to navigate the Medicare landscape by rating health plans on a five-star assessment grade.
Compare Benefits. Insurers often offer multiple Medicare Advantage plans from which beneficiaries can choose to fit their specific life, income and health situations. Benefits from these plans may include primary care and specialty office visits, routine physical and preventive care, unlimited medically necessary inpatient hospital days and worldwide emergency care. Some plans include membership in fitness classes and lifestyle enrichment programs.
Guard Against Fraud. The Centers for Medicare & Medicaid Services prohibit Medicare Advantage carriers from proactively contacting you by phone or in-person. They can only reach out to you once you have initiated contact. To protect yourself from potential scams, don’t give personal information to any uninvited home visitors or solicitors who call selling Medicare Advantage or Medicare Prescription Drug Plan products.If you’re approaching your 65th birthday, it is important to start considering Medicare options to select the plan that best fits all of your needs.
By Dan Tufto
Dan Tufto is President of Senior Products for Humana in Texas with responsibility for the overall strategic direction and growth of Humana’s Medicare Advantage business in the state.
[i] Administration on Aging, 2008 data – http://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx
[ii] Administration on Aging, 2008 data – http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/docs/By_Age_and_Gender_Persons_65_and_over.xls
[iii] Administration on Aging, 2005 data – http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/DOCS/State-persons_65-age-projections-2005-2030.xls
[iv] National Council on Aging, 2011 fact sheet – http://www.ncoa.org/improve-health/center-for-healthy-aging/chronic-disease
[v] Medicare.gov, no date – http://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-coverage-starts/when-coverage-starts.html