CT Watchdog: What you need to know about Medicare

Several Connecticut readers have asked me to provide more detailed information on Medicare. What better time than now, when those on Medicare have their annual opportunity to change their plans until Dec. 7.

First, if you are not covered under a group health plan, either from your own or spouse's current employment, you need to sign up for Medicare three months prior to turning 65. You can apply for Medicare online at www.socialsecurity.gov. It's convenient, quick and easy. It takes less than 10 minutes. The site also has FAQs to assist with other issues.

And assuming that you are on Medicare, you have several important choices to make in the next few weeks. If you are taking expensive medication, or have serious medical issues, it's even more important to make the right choice. And, because the rules have changed this year, you need to look at all the moving parts.

Frankly, choosing Medicare plans is a heck of a lot more complicated than picking health plans through work, where your choices are limited and, at many companies, the annual renewal packages clearly state the changes.

If this is the first year you are signing up or have found you paid a lot of money out of pocket for health care under your existing Medicare plans, I suggest you get help.

And The Wall Street Journal - which I consider to have some of the best consumer-related news - has done some of the work for us on where that help can be found.

HealthCPA.com in San Mateo, Calif., is one company that provides help for a fee. For $19.95 a month (with a 90 risk-free guarantee) plus $75 an hour if the issues are complex, the company will help you navigate the system and pick the right plan for you. It might be worth it.

"We're seeing these plans getting increasingly complex, with more fine print about what they will pay," Joshua Greenberg, president of HealthCPA, told The WSJ's Kelly Greene. "It could have huge financial implications."

"For example, if you need the arthritis drug Celebrex and your Medicare plan doesn't cover it, you could be out of pocket $1,176 a year," Mr. Greenberg says. "If it is covered, your out-of-pocket cost could be cut in half," he told The WSJ, which warns that if you seek "help from an insurance broker, or through a service run by an insurance company, you probably won't get a review of every option open to you."

Another source of great information - though your hands won't be held there - is Consumer Reports, which has tons of unbiased information on Medicare options on its website, consumerreports.org (for which you must pay an annual fee). I recommend that everyone have a subscription to both the print and online editions. The print edition is $29 a year and it's $20 or less for online.

Now, for the basics: Medicare comes in three parts:

• The one most of us have heard about is Part A, which covers hospital inpatient care, skilled nursing facilities, some home health care, and finally hospice care.

• The second one is Part B, which pays for doctor services and preventive care. The cost is dependent on your income and it starts at $115 a month up to $369 a month.

• The one that you need to probably pay the most attention to is Part D, which covers prescription drugs.

You have an alternative to these plans by purchasing a Medicare Advantage plan, which 25 percent of all seniors now use.

There are a whole host of companies that sell these plans and each one covers different medicine and different access to doctors and hospitals. Some plans have HMOs, which can make it difficult to get care out of network.

Consumer Reports recommends checking out "MedicareRights.org," noting, "That site has an excellent tool (http://www.medicareinteractive.org/#top) that will walk you through a comparison of original Medicare and Medicare Advantage."

You can reach The Watchdog at george@ctwatchdog.com and he will answer for free as many emails as he can. Please check out his site, www.ctwatchdog.com, for comprehensive consumer, health, finance, nutrition, Connecticut-grown food, elderly issues, media, Internet, computer, travel, auto, religion news and education tips.


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