Life After 50 Expo

Retiree Plans and Original Medicare ?

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How does retiree insurance work with Original Medicare?

Fee-for-service retiree plans: plans that pay for care from any doctor or hospital and generally fill gaps in Original Medicare so you don’t need to buy other supplemental insurance. These retiree plans also may pay for some of the costs that Medicare does not pay for, such as the 20 percent coinsurance for doctors’ services.

Managed care retiree plans (HMO or PPO): plans that generally pay for care only from network doctors and hospitals – likely will only fill gaps in Original Medicare if you get care from plan doctors and hospitals and follow the plan’s rules. If you use a non-plan doctor or hospital, Medicare will cover 80 percent of its approved charges, and the plan may or may not pay for any of the rest of the cost of these services.

Employer-sponsored Medicare Advantage Plans, such as Medicare HMOs and PFFS plans, are plans for retirees who are eligible for Medicare. You can get both your Medicare benefits and your retiree health benefits by signing up for a Medicare Advantage Plan that has a contract with your former employer. Some employers require that you join a Medicare Advantage Plan to continue getting retiree health benefits. You can always choose not to take your employer’s coverage. However, keep in mind that you may not be able to get that retiree coverage if you want it at a later date.

All retiree plans vary so call the Human Resources Department of the company through which you have retiree coverage to find out exactly what your retiree insurance covers and how it coordinates with Medicare.

Medicare Reminder !

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Many people are confused about which part of Medicare will cover their drugs. To answer this question, follow these general rules of thumb:

  • Part A will continue to cover the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility.
    Note: If you are getting skilled nursing care that is not covered by the Part A benefit, your drugs may be covered by the Medicare drug benefit (Part D) (if you are enrolled in a Medicare private drug plan).
  • Part B will continue to cover drugs administered by your doctor or at a dialysis facility, but the doctor or facility has to buy the drugs themselves. Part B also covers a limited number of outpatient prescription drugs, mainly certain oral cancer drugs (chemotherapy). Outpatient drugs previously paid for by Part B will continue to be paid for by Part B. Part D (see below) cannot pay for any drugs that are covered by Part B.
  • Part D covers outpatient drugs through Medicare private drug plans. If you join a Medicare private drug plan (Part D), it should cover most of the prescriptions your doctor writes for you to fill at the drug store. Check to see if your Medicare private drug plan includes the drugs you need on its list of covered drugs (formulary).

While some drugs are covered only by Part B, there are a few drugs that can be covered by either Part B or Part D depending on the circumstances.

Survey Highlights Prescription Drug Use Among Older Adults!

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This week, AARP released the results of a survey that examined consumers’ prescription drug use and opinions regarding cost. The survey captured common struggles consumers face with the cost of prescription drugs and consumer views on legal strategies to reduce prescription drug costs.

The online survey reached over 1,800 adults over the age of 50. Among survey respondents, 75 percent of take a prescription medication on a regular basis, with an even higher percentage for those ages 65 and older. Of these, over 80 percent take at least two prescription drugs and over 50 percent take four or more. African American and low-income individuals tend to take more medications.

Nearly 30 percent reported that out-of-pocket prescription drug costs are increasing, and 33 percent had a monthly expenditure of $50 or more. Over four in ten adults age 50 and older are concerned about being able to afford their medication. About one-quarter (23 percent) of those surveyed did not fill a prescription they were given within the last two years, and over 55 percent of those reported that cost contributed to the decision not to obtain the medication.

Most adults age 50 and older reported that prescription drugs are too expensive and most say it is important for policymakers  to support efforts to make prescription drugs more affordable. For instance, three-quarters of survey respondents thought that there should be more government regulation limiting the cost of prescription drugs.

Does Aging Affect Our Sense of Smell ?

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An individual’s sense of smell can decrease as they get older, but these changes are not noticeable right away. It is important for people to protect their sense of smell because it plays an important role in alerting them to danger such as spoiled food, gas leaks, and smoke from a fire. Smell disorders can also be indicative of other health conditions. To protect the sense of smell, the National Institute of Health (NIH) Senior Health recommends the following:

  1. Treat sinus and nasal conditions. Swollen sinuses and nasal passages may contribute to a decreased sense of smell.
  2. Avoid head injuries, and seek treatment if you suffer such an injury. Head injuries can lessen an individual’s sense of smell.
  3. Avoid exposure to toxic chemicals. Wear a respirator when using paints and insecticides.
  4. Treat other conditions. Individuals with diabetes, thyroid abnormalities, or certain vitamin deficiencies may experience a loss of smell or taste.

Dear Marci,

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Dear Marci,

I will turn 65 soon and be eligible for Medicare. I am still working and receive health insurance from my employer. If I sign up for Medicare, how will it work with my current employer-based insurance?

– Marco (Montclair, NJ)

Dear Marco,

This is a common question. As more people continue to work past age 65 and receive employer health benefits, they have questions about Medicare coverage. Learning about how Medicare works with your current employer insurance can help you decide if you want to sign up for Medicare when you become eligible. Note that when we say “current employer insurance,” we mean insurance from either your or your spouse’s job.

The first thing to think about is whether Medicare will pay primary or secondary to your current employer insurance. Medicare paying primary means that Medicare pays first on health care claims, and your employer insurance pays second on some or all of the remaining costs. Medicare paying secondary means that your employer insurance pays first, and Medicare pays on some or all of the remaining costs.

Medicare works with current employer coverage in different ways depending on the size of the employer. For people who are eligible for Medicare because they are 65 or older,Medicare pays primary if the insurance is from current work at a company with fewer than 20 employees. This is called a small group health plan. Medicare pays secondary if the insurance is from current work at a company with more than 20 employees. This is called a Group Health Plan (GHP).

If you have insurance from your or your spouse’s current employer when you become eligible for Medicare, you may think about delaying Medicare enrollment. If you are covered by current employer insurance—regardless of the size of the employer—you can delay Medicare enrollment without penalty. (Those who work at companies with fewer than 20 employees may want to sign up for Medicare since it pays primary. I explain further in the next paragraph.) You will have a Special Enrollment Period (SEP) to enroll in Medicare at any point while covered by the employer plan or up to eight months after the first month you are without that employer coverage. To avoid gaps in coverage, it is often wise to sign up in the month before employer coverage ends.

Before you delay Medicare enrollment, note that you may encounter some problems if Medicare is supposed to pay primary.

  1. Your employer plan may refuse to make payments until Medicare pays.
  2. If your employer plan pays primary but was supposed to pay secondary, it may recoup payments, leaving you responsible for the out-of-pocket costs.

– Marci