Wednesday, November 4, 2020 The Nugget Newspaper, Sisters, Oregon MEDICARE: Guidance through the maze is available locally Continued from page 3 plans include Part D prescrip- tion drug coverage. With Part C coverage, you are in a local network so you must use the providers who are part of that network. If you seek medical care out- side of your network (another county or state), you are responsible for 100 percent of the charges. With Part C you can lose control of your healthcare decisions 4 the freedom to be treated where and by whom you choose. Part D (Prescription drug plans): These are insurance plans designed to cover part or all of the cost for prescrip- tion drugs. The coverage period runs from January 1 3 December 31 each year. Simply stated, find a well- ranked company (one to five stars) with low premiums where you can use the phar- macy of your choice. But there are lots of factors to take into consideration when choosing the best drug plan for you, like restrictions on quantity limits and step ther- apy. If it doesn9t work out the way you expected, you can change plans each October 15 3 December 7. There are several ways to obtain Part D. A stand-alone policy (PDP), which is not linked to any other part of Medicare, can be purchased. Each year you can shop for a new policy without mak- ing any changes to any other part of Medicare. If you are happy with your plan you need do nothing. It will just roll over, but things change every year so it9s a good idea to make sure your plan still meets your needs. With Medicare Advantage plans, Part D is bundled with the plan (MAPD). You have no choice of carriers and can9t make changes. You also can- not have a stand-alone drug plan with your Medicare Advantage plan. Each company has its own formulary, which is the list of drugs covered by the company9s plans. Each plan has five tiers or levels of cost sharing based on generic and preferred brand-name drugs and the relationship that the CORRECTION One of the project funders identified in The Nugget9s story <Locals raising funds for Link Creek= (October 28, page 3) was incorrectly iden- tified. Funding for the proj- ect also came from Portland General Electric through their Pelton Dam Fund, which sup- ports conservation, water quality and promotes fish passage and improved habi- tats for fish above the dam. Medicare definitions Annual election period (Open Enrollment) 3 every year the period of October 15 3 December 7 to make changes to your coverage. Co-pay 3 portion of bill you pay, after deductible is met. Original Medicare 3 foundation of Medicare. Includes Parts A and B. Is accepted in any state for any Deductible 3 Amount you doctor or facility accepting pay out of packet before the Medicare. Provides personal plan pays. control over your health Co-insurance 3 percentage care and gives consumer the freedom to choose of bill you have to pay after deductible and co-pay, their doctor (including usually 20 percent of charge. specialists). Doesn9t by itself limit (put a cap on) your financial exposure. Large Premium 3 amount you medical costs could create pay to have insurance if Part B, C, or D. financial hardship. insurance company has with the drug manufacturers. Each plan has different premiums, and different prices for each drug, and may utilize a dif- ferent network of pharma- cies. All insurance companies are regulated to meet certain minimum requirements for drug categories and six pro- tected classes of drugs, but they can each cover different prescriptions and can charge different prices. Medigap (supplemental): If you have Parts A and B, and can afford it, adding a supplemental policy can help avoid large medical expenses because it puts a cap on charges. These plans are sub- servient to Medicare A and B. They are offered by a number of private insurance compa- nies but are regulated because these policies are written into Medicare law. There are 10 different plans available, denoted by letters like F, G, and N. Each plan is identical from one company to another in what they offer. The differ- ences are in price and pricing strategies of the companies. They each have their own premiums depending on the coverage offered and the amount of the deduct- ible. No permission is needed for medical services, so the policy holder has con- trol. If a provider accepts Medicare, they will accept your Medigap insurance. This coverage is especially good at paying the 20 percent that Medicare doesn9t, so you aren9t stuck with paying a big balance. There is a six-month win- dow to get a supplemental plan of your choice with- out going through medical underwriting. The window starts the day you enroll in Medicare B and extends for 15 Local resources Linda Alldredge, Country Financial 178 South Elm St., Sisters 541-549-6946 Senior Health Insurance Benefits Association " Oregon Guide to Medicare Insurance Plans available online at www. healthcare.Oregon.gov " Statewide number to talk with SHIBA representative for free, 1-800-722-4134 For first-time Medicare applicants 3 www.medicare startsat65.oregon.gov six months. After the six- month window, you can still get a supplemental plan, but you have to get medically qualified. The insurance com- pany looks at your significant medical history, and if it includes serious conditions, you may not be able to get Council on Aging of Central Oregon 373 NE Greenwood Ave., Bend 541-678-5483 Social Security " 1-800-772-1213 for Medicare A & B questions " 1-800-633-4227 for Part D questions Matthew Classen CMT YouTube series on all aspects of Medicare www.medigapseminars.org 1-800-847-9680 coverage. 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