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Medicare 101 seminar held at American Legion

August 23, 2017
By ED FRANKS ( , Pine Island Eagle

Thursday morning about 15 - 20 people arrived at the St. James City American Legion Post #136 for the third annual Medicare educational seminar and lunch. Insurance Options Inc. agent Katherine Thousand made the presentation.

Commander Tom Lewis introduced Thousand.

"This is just an introduction to the Medicare program," Lewis said. "There are some things you need to know, some things you should know, but no one is here to sell you anything. This is purely educational."

Article Photos

Katherine Thousand and Commander Tom Lewis at the Medicare presentation at the American Legion Post.


"This seminar is for anyone who has questions about Medicare, are turning 65 soon, may have retired recently or has relocated to Florida," Thousand said. "It's important to know what your option are."

Topics covered were: original Medicare, Medicare supplements, Medicare advantage and enrollment periods.

Original Medicare was created by Congress in 1965 as the traditional fee-for-service program offered directly through the federal government.

"Medicare provides insurance to people 65 years of age or older or people with certain disabilities recognized by Social Security," Thousand said. "You can see any doctor and hospital that takes Medicare anywhere in the country. Baby Boomers are signing up for Medicare at 10,000 per day."

"Original Medicare consists of two parts: Part A and Part B," Thousand said. "Part A helps with your hospital, skilled nursing, home health care and hospice. Part B helps with doctors in and out of the hospital, preventive services, diagnostic testing and DME (durable medical equipment such as canes, crutches, hospital beds, etc.)."

In addition to Parts A and B, there is also Part C, sometimes called Medicare Advantage Plans. These are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Part D adds prescription drug coverage to your Medicare plan through private insurance company.

"Part A is free for everyone that has worked at least 40 quarters (10 years) or qualifies under their spouses benefit," Thousand said. "Part B is for doctors and outpatient coverage. This is not free. The average cost in 2017 is $134 per month and is automatically deducted from your Social Security check. If you were receiving Part B prior to 2016, it's $109 per month."

The Part A deduction for 2017 is $1,316 and covers a semi-private room and board (not doctors) for stays up to 60 continuous days. After 60 days the hospital charges $329 per day. At 90 days that adds up to $11,186. On the 91st day there is a "Lifetime Reserve Days" provision where the hospital can charge $658 per day.

"Part B covers doctors, blood work, diagnosis, etc.," Thousand said. "There is an annual deductible of $166 and Medicare pays 80 percent of the bill."

"If you feel your family is healthy and you don't want to spend the extra money, you can just sign up for Medicare Part A," Thousand said. "Most Americans wind up paying the lowest premium for Part B and some add the prescription coverage.

"Medicare supplement plans you can purchase to cover the gaps in Medicare," Thousand said. "They are also known as 'Medigap plans.'"

There are 11 standardized Medicare supplement plans: A, B, C, D, F, G, K, L, M & N. Plus High F. Each of these plans provides the same coverage regardless of the carrier, require a monthly premium based on age, ZIP code, gender, etc. Most of these plans have a prescription plan built in.

"The Medigap plans are run by private insurance companies who have an annual contract with Medicare," Thousand said. "These plans can change annually. There are HMO (Health Maintenance Organization) plans; PPO (Preferred Provider Organizations); SNP (Special Needs Plans. Applicants must meet eligibility requirements."

Prescription drug plans are under Medicare Part D. These benefits are available to all people with Medicare and requires Part A and/or B. They are provided through stand-alone Medicare Prescription Drug Plans, Medicare Advantage Plans and some employers or unions. Premiums can range from $15 to $100 per month.

"For those that choose to opt out of the drug plan when they sign on to Medicare and wait, there is a penalty," Thousand said. "Once the government fixes your penalty you will pay that for the rest of your life."

The Initial Enrollment Period for those new Part B (turning 65 for example) lasts for 7 months. Three months before the birth month, the birth month and three months after the birth month. Coverage begins no earlier than the first day of the eligible month. For Part C Advantage Plans & Part D prescription drug plans is from Oct. 15 through Dec. 7. Coverage begins Jan. 1.

The Centers for Medicare & Medicaid Services has a booklet entitled "Medicare & You 2017." The booklet is available to download from website.

Insurance Options is located at 1401 Viscaya Parkway, Unit 2, Cape Coral. Thousand is available to answer questions at 239-201-4560.



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