October 15 begins open enrollment for Medicare beneficiaries and continues through December 7. For many, Medicare is overwhelming and confusing. At Ashe Senior Center, we have 9 dedicated counselors that are ready to answer your questions and help you make the best decisions on which plan will be best for you. Here are some important highlights regarding Medicare….

What is a Medicare Supplement (or Medigap) Plan?

Medicare supplement plans are one health insurance option for people with Original Medicare. There are standardized Medicare supplement insurance plans available that are designed to fill the gaps left by Original Medicare (Parts A and B). These are sold by private insurance companies as individual insurance policies are regulated by the Department of Insurance. After age 65 and for the first six months of eligibility for Medicare Part B, beneficiaries have an Open Enrollment Period and are guaranteed the ability to buy any of these plans from any company that sells them. Companies cannot deny coverage or charge more for current or past health problems. If you fail to apply for a Medicare supplement within your Open Enrollment Period, you may lose the right to purchase a Medicare supplement policy without regard to your health.

What are Medicare Advantage Plans?

A Medicare Advantage Plan is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans”, are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get the most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare Prescription drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. However, many plans offer out-of-network coverage, but sometimes at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

Prescription Drug Assistance Available for Low-Income Medicare Beneficiaries

Medicare beneficiaries who have limited incomes and assets may be eligible for Extra Help to pay for their prescription drugs. The federal Low-Income Subsidy (LIS) program, also known as Extra Help, assists qualified Medicare beneficiaries with out-of-pocket expenses associated with Medicare Part D prescription drugs.

To qualify for Extra Help, a Medicare beneficiary must meet certain income, resource and asset level requirements. The income and asset limits for Extra Help are $1,508 per month with assets up to $13,820 if you are single, and $2,030 per month with assets up to $27,600 if you are married.

Combatting Medicare Fraud and Abuse

The North Carolina Senior Medicare Patrol (NCSMP) Program is housed within the Seniors’ Health Insurance Information Program (SHIIP) at the North Carolina Department of Insurance. NCSMP is a preventive educational program whose goal is to reduce Medicare error, fraud, and abuse through statewide coordinated efforts of educational and promotional activities and to encourage reporting of discrepancies by Medicare beneficiaries and caregivers to the NCSMP Program.

Did you know?

• 68 billion dollars of the taxpayers’ money is lost annually to billing discrepancies, fraud, abuse and waste in the Medicare program.
• “Fraud and abuse” in the Medicare program often times are actually billing errors or discrepancies.
• The process of reporting suspected fraud, abuse and waste is to contact the provider to seek resolution; to contact their Medicare carriers and insurance companies and to file an appeal by following the appeal instructions found on the back of the Medicare Summary Notice. And if your situation is not resolved satisfactorily, you should contact the North Carolina SMP Program at the nationwide toll-free number, 855-408-1212.

Remember to:

• review your Medicare statements
• protect your Medicare number
• do not be influenced by advertising for services, medications or products that sound “too good to be true”
• educate yourself about your Medicare benefits
• rarely are Medicare services “free”
• Medicare does not solicit door-to-door

Call our Senior Center today to make an appointment during Open Enrollment. In 2019, SHIIP counselors were able to save North Carolina Medicare beneficiaries $54,779,654. In Ashe County, residents saved $1.1 million! Let our volunteers help you find the best plan for you! Our Senior Center will be taking appointments Monday-Friday, October 15 through December 7. Call 336-246-4347 today to make your appointment!

*The information contained in this blog was provided by the North Carolina Department of Insurance. Further information may be found by visiting www.ncdoi.gov.