Written by Barry Klitsberg, Nassau County Medicare Counselor, FCA
Enrolling in Medicare can be confusing. Family and Children’s Association’s (FCA) Free Nassau County Health Insurance Information Counseling and Assistance Program (HIICAP) can help with enrollment guidance by phone.
The Open Enrollment season for people who are currently enrolled in Medicare ended December 7, 2022, but there is another potential opportunity to switch Medicare health plans for those currently enrolled in a Medicare Advantage Plan (HMO or PPO).
The additional Open Enrollment season runs from January 1 through March 31, with any changes effective the first day of the month following enrollment. There is also the opportunity to drop your Medicare Advantage Plan and return to traditional Medicare during this time, although you would also need to sign up for a Medicare drug plan. If you find that the plan in which you are currently enrolled does not work for you, this added flexibility can help you find a new plan that better suits your needs.
Please note, that if you were not currently enrolled in a Medicare Advantage Plan, you cannot sign up for one at this time. The current enrollment period only allows people to switch or drop a plan.
Income Limit Increase Helps More People
The Medicare Savings Program has dramatically increased the income limits for eligibility. This program can help pay your Medicare Part B premium and can dramatically lower your drug costs. If you were previously found to be ineligible for this program, you should call Family and Children’s Association’s (FCA) Nassau County Health Insurance Information Counseling and Assistance Program (HIICAP) office to see if you are now eligible.
Medicare coverage can be confusing for the uninitiated, as there are various options. Choosing the right plan for you requires careful consideration. If you need help understanding or choosing a plan, FCA can help guide you through the process with free help by calling 516-485-3754.
There are four basic parts of Medicare:
Hospital Insurance (Part A) covers you as an inpatient in a hospital or skilled nursing or rehabilitation facility, or for skilled home care after a hospitalization. Medicare Part A also can cover hospice care if you have a terminal illness. For most people Medicare Part A is premium free.
Medicare Medical Insurance (Part B) covers physician and other outpatient services. These services include doctor visits, hospital outpatient services, lab tests; physical, speech or occupational therapy; and durable medical equipment for use in the home. The standard Part B premium amount in 2022 is $164.90. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Medicare (Part C) You may opt for Medicare Advantage plans instead of Part B. Medicare are managed care plans including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). These plans generally have a network of providers. In an HMO you must use providers in that network. If you join a PPO, you can go out of the network, but you will have a higher copayment for out of network services. Medicare Advantage plans generally cover prescription drugs, otherwise covered by Medicare Part D, and frequently cover non-Medicare services such as vision, dental and hearing services.
Medicare (Part D) is prescription coverage. There are 19 drug plans in New York State. These plans vary in premium cost and formularies.
Medigap
There are Medicare supplement plans known as Medigap. These are standardized plans that can fill most of the Medicare gaps such as deductibles and co-insurance.
For more information about these changes to Medicare and for any other information pertaining to your health benefits, you can call our office at 516-485-3754 and a trained counselor will assist you.
Barry Klitsberg is an Assistant Health Insurance Information Counseling and Assistance (HIICAP) Coordinator at FCA in Garden City and an Aging Services Program Specialist at US Department of Health and Human Services.
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