Making sense out of Medicare
VCU School of Pharmacy faculty, alumni and students have provided the Dr. Rx column for Richmond’s Fifty Plus magazine since December 2009. We now share those columns on the SOP website, as well, for those who might not have seen the most recent issue.
Serving as Dr. Rx for September 2015 was Lauren Fruhling, a fourth-year Pharm.D. student who earned her bachelor of science degrees in kinesiology and human nutrition at Arizona State University. Her interests are emergency medicine, critical care and infectious disease.
Q.: I turn 65 this year and just started getting lots of mail about signing up for Medicare. What are all the different kinds, and how do I pick the best plan?
A.: To start, Medicare is a government-sponsored insurance program for individuals older than 65 as well as younger people with disabilities. Money has been deducted from your paychecks throughout your career to fund these insurance plans.
This is different from Medicaid, a separate government-sponsored insurance program. Whereas Medicare eligibility is traditionally age-based, Medicaid eligibility is based upon financial status to allow disadvantaged individuals access to health care.
You have probably started getting information in the mail because open enrollment for Medicare begins three months before the month of your 65th birthday. You have until three months after your birthday month to enroll without penalties.
While you can enroll after this period during the general enrollment (every year between Jan. 1 and March 31), you will incur a late penalty and pay higher monthly premiums for your coverage. If you currently have private insurance through your or your spouse’s work, you can wait until you will no longer have coverage before signing up for Medicare. This is called a Special Enrollment Period, which gives you eight months from the date of losing your insurance to sign up for Medicare without paying a penalty.
There are four main types of Medicare that you potentially could use. Part A is your coverage for hospital charges. Part B covers your doctor’s visits and medical supplies, such as walkers and diabetes test strips. Part C is also called Medicare Advantage and can offer extended benefits, such as vision and dental coverage, if you already have part A and part B. Part D covers your medications.
To pick the best plan for you, try visiting http://medicare.gov or calling (800) MEDICARE [633-4227]. You’ll find a wealth of information regarding the various plans. Under the “Sign Up” tab online, there is a link to “Find health & drug plans.” This link will allow you to fill in your health information and list of current medications. In turn, it will show you the most cost-effective plans for your specific health concerns.
It is important to consider all aspects of choosing a plan. Each plan has a different formulary, or list of approved medications. If you already take medications, it would be worthwhile to choose a plan that covers your current medications.
Financially, there are three factors to consider: monthly payments, deductibles and copays. The monthly payment is what you will owe every month regardless of how much you use your plan. The deductible is a set amount of money you must spend before reaching full coverage through your plan. Many plans now have high deductibles, which can increase what you spend at each prescription fill and with each visit to the doctor. Copays are what you owe with each prescription and are separate from your monthly payment.
If you have any unanswered questions about enrolling, visit your local pharmacy. The pharmacist is trained to navigate the insurance system. And while your pharmacist cannot tell you which plan to select, he or she can help you better understand your options to make an educated decision.
The Virginia Division for the Aging’s Virginia Insurance Counseling and Assistance Program also might be able to assist you. For information about VICAP, email [email protected] or call (800) 552-3402.
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