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. Many people new
to Medicare think, because
they are healthy and have
low medical expenses, they
don9t need a Medigap policy.
But as the years pass, serious
medical conditions can arise
and then you will be unable
to qualify.
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