Deciphering Medicare

All seniors should check their Medicare prescription plan (Medicare Part D) and options for Medicare Advantage before the Dec. 7 Medicare Open Enrollment deadline, says Samuel Weiss, who serves as a long-term care ombudsman.

As an advocate for residents of senior care facilities, including Robison Jewish Health Center and Rose Schnitzer Manor, Weiss helps seniors navigate what can seem to be a daunting task.

“It is not that difficult,” he says. “Medicare.gov takes you step by step through the process of seeing what plans are available. If people just read and follow through with a list of medicines they take, it does a great job. That’s what I do with residents at Rose Schnitzer when they ask for assistance.”

Seniors should review their Medicare plan every year, since their needs and medications often change, and the plans that are available change too. Medicare.gov can compare your current plan to all plans available in your area for the coming year, says Weiss.

It is important to consider the total out-of-pocket expense of a plan, he adds. Some people focus on the monthly payment or the co-pay for medication but don’t check that their medications are covered.

“The key is formulary,” he says. “Not all plans cover all medications. Enter all your medications, dosage and frequency (on Medicare.gov). That tells you what it will cost you.”

He says seniors should also look at the Medicare Advantage options available in their area. While traditional Medicare allows seniors to use any provider that accepts Medicare, Medicare Advantage plans give seniors access to the providers in a particular network, such as Kaiser and Humana. The Affordable Care Act has impacted the Advantage plans so seniors should look at what options fit them best, Weiss says.

The AARP website (aarp.org) includes the following description of Medicare Advantage (Part C) in an article by AARP Bulletin Senior Editor Patricia Barry: “This option provides several different alternatives to traditional Medicare, each offered through many private insurance plans that Medicare approves and regulates. Every year Medicare gives each plan a set amount of money toward the care of each person enrolled in the plan, regardless of how much health care he or she uses, and you pay what the plan requires for each service. Each plan must provide at least the same services as traditional Medicare but may offer extra benefits.”

Both Weiss and Michele Blackwell, director of Jewish Family & Child Service’s Lifeline program for seniors, recommend contacting the SHIBA program (Senior Health Insurance Benefits Assistance) for help deciphering the options. Contact SHIBA at 1-800-722-4134 or www.oregon.gov/DCBS/SHIBA.

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