Ever since the Medicare Annual Election Period kicked off on November 15^th, I’ve been very busy talking to seniors about their Medicare coverage. Here are a few of the people I’ve met and their stories.

Lydia is 80-years old and looks and acts like she’s 70. She must have good genes, but she also has a wonderful, upbeat attitude about life - which probably has a lot to do with her good health.  Lydia lives on less than $900 per month from Social Security and she never realized she qualified for help from the state. I helped Lydia fill out the forms to apply for Medicare Cost Sharing and Lydia heard back from AHCCCS (Arizona Health Care Cost Containment System) in just two weeks.   

Starting in January, the state will pay Lydia’s Medicare Part B premium ($96.40) as well as any co-pays she has for medical care. Medicare will pay first and AHCCCS will pay the balance. This will take a big load off Lydia’s mind.

Lucille is 78 years old and is concerned about all the co-payments that are part of her Medicare Advantage plan.  She has been having dizzy spells and went to her primary doctor for a checkup. Her primary doctor sent her to a specialist, which cost her a $40 co-pay.  That specialist sent her to another specialist, for another $40 co-pay.  That doctor sent her to yet another specialist, so she had to pay one more $40 co-pay. 

This last doctor told Lucille he could probably treat her problem, but that Medicare does not cover the service, which would cost about $300. Lucille is frustrated, confused and out a lot of money.

During Medicare’s Open Enrollment Period, January – March, seniors enrolled in Medicare Advantage plans can drop their private plan and go back to Medicare.  This is one more choice seniors have concerning their Medicare coverage.

I recently wrote about changes seniors can make between January 1st and March 31st, and I was focused on changing from one Medicare Advantage plan to another.  But I neglected to provide an example that some folks might want to consider in early 2010 – going back to Medicare.

Example:  Mr. Jones is 67 and has been enrolled in a Medicare Advantage HMO plan since he turned 65. In January  he’s thinking this is not the right choice for him because he plans to spend several months outside of  Arizona where his Medicare Advantage HMO plan will cover him only in an emergency. He’d like to be able to see doctors when he’s in Massachusetts during the summer, but he can’t do this if he’s enrolled in a Medicare HMO. 

If Mr. Jones is relatively healthy, he can apply to any Medicare Supplement company and they will check his medical records to decide if they should take him on.  Or, Mr. Jones could apply for AARP’s Medicare Supplement, which takes  seniors with no medical questions asked until they are 68. 

Once Mr. Jones hears that his Medicare Supplement has been approved, he needs to sign up for a stand-alone Part D plan.  Mr. Jones has had a Part D plan as part of his Medicare Advantage plan, so Medicare will allow him to replace that Part D plan with a new stand-alone plan.  When Mr. Jones’ Part D application gets to Medicare, Medicare will terminate his Medicare Advantage enrollment and notify his plan. Then Medicare will put his stand-alone Part D information into his record.  At the beginning of the next month (February in this case), Mr. Jones will have the following coverage:  Medicare as his primary payer; the Medicare Supplement as his secondary payer; and a stand-alone Part D plan for his prescriptions.

This is an important choice for consideration during the Open Enrollment Period (January – March).  I have worked with a number of adult children who are taking care of their elderly parents and were confused by all the co-pays involved in Medicare Advantage plans.  For simplicity (and better coverage) these caretakers decided they wanted their parents back on Medicare with a Supplement. 

Medicare with a Medicare Supplement (and a stand-alone Part D plan) costs more up front, but can be well worth it if a person travels or is a snowbird.  And it’s definitely worth it when a person’s medical condition requires lots of doctor visits, ambulance trips, and hospital stays.

Confusion is in the air as Medicare Advantage cards and calls are arriving this week.

Seniors who have changed Medicare Advantage plans  may be in for some confusion when they receive an ID card from their current plan before they receive a card from their new plan (for 2010).  The Advantage plans assumed (and hoped) that people enrolled in their plans would stay put for 2010, so they’ve sent ID cards for 2010.  However, quite a few people put in applications to change plans and they haven’t yet received their new plan ID cards.  I’ve had two calls and an email this week from confused clients.

A bit more confusion is being added to the mix as Medicare is requiring Advantage plan companies to call everyone who enrolls in their plans to quiz them on how much they understand about what they signed up for. These are called “verification calls”.  Part D enrollees are getting calls as well.

I was talking with an agent who told me about her client who got a call from Health Net to verify her enrollment in one of their plans. This lady was already a bit confused because she had just received an ID card from Secure Horizons (the plan she wanted to leave).  Then she got the call from Health Net  quizzing her about the plan for which she had filled out an application a month earlier.  After a few questions this lady got very anxious and told the caller she had NOT enrolled in Heath Net and would not answer any more questions.  Yikes! 

I have written about how confusing Part D plans and Medicare Advantage plans can be for seniors when they are face-to-face with an insurance agent.  Now they are getting quizzed about the details of meetings they had a month previously.  

Once again, Medicare coverage has become even more complicated, causing lots of confusion. What a great system!