Help navigating Medicare mire

WASILLA — Despite whatever comes out of the national health care debate, changes are coming to Medicare, and many seniors need to act now.

Medicare Advantage, the program that allows seniors to use private heath care providers to administer their Medicare benefits, is coming to an end in Alaska on Dec. 31.

Many of these seniors will need to enroll in Medicare Part D to continue their prescription drug benefits. However, the current period of open enrollment for Medicare Part D ends on Dec. 31.

But seniors facing this transition should fear not, for there is help.

Judith Bendersky runs the Medicare Information office as part of the state’s Senior and Disabilities Service. Her office serves 56,000 people statewide and provides free answers about the confusing system.

“What we do is help people navigate Social Security, Medicare and sometimes Medicaid. We also help people with limited income qualify for additional benefits,” Bendersky said. “We answer any sort of question, especially with enrollment.”

Bendersky said she gets a lot of inquiries from worried 64-year-olds looking at Medicare for the first time. She offers one-on-one consulting for anyone interested by calling 269-3669 or at www.medicare.alaska.gov, but there are some standard rules.

Seniors do not have to give up their private insurance if they are still working, Bendersky said. Instead, Medicare can become a secondary policy that can help cover what the private insurance does not, she said.

However, once retired, Medicare automatically kicks in as the primary insurance. Any other policy, whether through the military or Alaska Native benefits or a plan paid for by a past employer, becomes the supplemental policy, she said.

“To a lot of people, this comes as a big surprise and disappointment. People are used to their private health care plans,” Bendersky said.

The supplemental policies can pick up the other 20 percent of health care costs not covered by standard Medicare.

Medicare comes in four parts. Medicare Part A is what people pay into through their Social Security taxes and goes toward hospitalization coverage, Bendersky said. Part B covers outpatient treatment and medical supplies. Part D covers prescription drugs.

Part C is also known as Medicare Advantage. Bendersky said it is ending on Dec. 31 because it is not feasible for private providers in the state to continue the program. As Medicare typically reimburses medical expenses at 30 to 40 cents on the dollar, more doctors are turning Medicare patients away and private insurers are less likely to pick them up, she said.

“Alaska has such a small population … and an extreme doctor shortage. There are plenty of priority insured people, low reimbursement rates and high costs,” Bendersky said.

Anyone who is getting dropped from Medicare Advantage should consider picking up Medicare Part D as well as MediGap, she said. MediGap is supplemental insurance that pays expenses not paid for by the traditional coverage.

“The different parts come a la carte. People have different needs and buy different coverage,” Bendersky said. “That’s what makes it so confusing.”

Bendersky said she often sees people who are underinsured, paying too much in out-of-pocket expenses.

“You don’t have enough insurance if you are paying $300 a month for prescriptions,” she said.

But, she said she also sees people with too much insurance.

“If someone is only using their (Veterans Administration) benefits for their prescriptions, but they have MediGap and Medicare Part D, they are probably over insured,” Bendersky said.

Everyone receives a packet explaining the ins and outs of Medicare when they first enroll, but with hundreds of exceptions to the rules, Bendersky said it is always best to consult with her office with any questions about any changes.

Bendersky warned that seniors can only modify their Medicare coverage during open enrollment periods, and each different part has a different open period. That is why it is so crucial for seniors with Medicare Advantage to pick up Medicare Part D before the end of the year, she said.

As to what would happen if some of the new proposed changes went through, Bendersky said allowing 55-year-olds to enroll in Medicare would require a huge increase in federal funding to her office and Medicare health providers.

“It can’t be a good thing unless reimbursements rates are adjusted or the Feds increase the funds for community health centers that accept Medicare patients, like the Mat-Su Health Services,” Bendersky said.

Contact Todd L. Disher at todd.disher@frontiersman.com or 352-2252.