SOUTH COUNTY- One small change in an insurance policy can make a big difference.
What if your doctor doesn’t accept your health plan anymore? Or a medicine you take regularly is no longer covered under your current plan?
These are only two of the long list of reasons experts advise everyone to check their Medicare policy before the annual window to change policies closes at midnight Dec. 7.
“It’s very important that you review your policy because every year the insurance companies change something,” said Jim Mulcahy, area coordinator of five counties, including Hillsborough, for SHINE; Serving Health Insurance Needs of Elders. (Those coming to Florida from other states may recognize this program as SHIP. Only Florida and Massachusetts call it SHINE.) “If you just assume things are the same as before you could end up going to your doctors and finding out they no longer take your insurance. You could be stuck seeking new providers after the fact.”
It’s always better not to risk having surprises, said Anna Lonas, an independent health care advisor who explains policies to South County residents on a regular basis. Because Lonas is an independent agent and does not work for any one insurance company, she and others like her can look for the policy that is best for each individual, depending on their circumstances.
“What’s good for one person isn’t always good for another even though it may look like they have similar circumstances,” she explained. “Everyone’s health care needs are different. Having your own advisor you can call upon during the year with questions is an important factor in your health care.”
Whether you meet with Lonas in Sun City Center at one of her regular stops including the Kings Point Clubhouse or call a SHINE volunteer at 800-963-5337 or rely on 800-Medicare (800-633-4227) all the experts agree it is important to check your coverage during the annual enrollment period which extends from Oct. 15 through Dec. 7.
“We advise everyone to take a close look at their policy during open enrollment,” said Paula Nelson at the West Central Florida Area on Aging. “That way there shouldn’t be any surprises.”
People turning 65 should consult someone about their initial sign-up for Medicare three to four months before their birthday so they can understand exactly what action they need to take on their part to best serve their personal situation, Lonas said.
She pointed out that higher premiums could be charged in some cases if a person does not sign up when they are first eligible.
“There can be penalties,” she explained. “And this makes it very important people turning 65 take their Medicare whether they need it then or not.”
People with what Medicare terms “credible coverage” may sign up later without paying a higher premium, Mulcahy said. “This would be the case if you or your spouse had coverage through a job that ends after you turn 65.”
Upon the end of employment, taking COBRA or something else offered by the former employer or employment-based insurance company instead of Medicare is a costly mistake made by many people over 65, experts agreed.
“Take your Medicare as soon as you become eligible,” is the advice of all who were contacted.
“Part A (hospital insurance) is automatically placed on you at 65 because people pay it in through FICA all during their working years,” Mulcahy said. (FICA is the Federal Insurance Contributions Act, which is actually a prepayment into Social Security through the government tax system.) “It’s the Part B (medical insurance) where you make choices.”
Part B is where you can choose either regular Medicare or from a variety of “Medicare advantage plans” that are HMO’s or PPO’s. People taking regular Medicare also have to make choices about supplemental plans to cover what Medicare does not, while some advantage plans are used to cover all health care needs in one bundle.
“Each person’s needs are different and that’s what you must consider when choosing a plan,” Lonas said.
To find out more visit www.medicare.gov, the official government site for Medicare; SHINE; or any independent agent who can compare plans free of charge in time to get your application in and approved before the deadline Dec. 7.