Take the Rx Enrollment Check-up Today, and Get the Most Out of Your Medicare
Medicare’s open enrollment starts November 15. Now is the time to evaluate your current plan—has it met your needs this year? Medicare recommends taking this quick Rx Enrollment Check-up. If you are satisfied with your plan,you do not have to do anything to re-enroll. Take a few minutes now and ask yourself these three questions:
COST: Will your premium and costs change in 2007?
COVERAGE: Do you need more coverage in 2007? Will the prescription drugs you take be covered by your plan in 2007?
CUSTOMER SERVICE: Are you satisfied with your plan’s service?
Do you need help paying for your prescription drug coverage? Now, a Medicare prescription drug plan may be an even better deal for you if you are a Medicare beneficiary with limited income and resources. You may qualify for extra help that will make your low monthly premiums, deductibles and co-payments even lower—much lower. To get the most from this special benefit, act now.
What is the "Extra Help"?
If your annual income is below $14,700 for an individual ($19,800 for a married couple living together), you may not have to pay monthly premiums or deductibles, and you could pay as little as $2 for your co-payments.
Even if your annual income is higher, you still may be able to get some help with your monthly premiums, annual deductibles and prescription co-payments. For example, your income may be higher and you possibly could get extra help if you or your spouse:
—Support other family members who live with you; —Have earnings from work; or —Live in Alaska or Hawaii.
To qualify, your resources must be limited to $10,000 for an individual ($20,000 for a married couple living together). These resource limits can be slightly higher (an additional $1,500 per person) if you will use some of your money for burial expenses. Resources include such things as bank accounts, stocks and bonds. Your house and care are not counted as resources.
How can I get more information?
For more information about getting help with your prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), visit www.socialsecurity.gov or call KIPDA at 502-266-6084 or 1-888-737-3363.
To learn more about the Medicare prescription drug plans, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), visit www.medicare.gov or call KIPDA at 502-266-6084 or 1-888-737-3363.
Are You Having Trouble Getting a Prescription Filled?
KIPDA
If your medication isn't covered by your prescription drug plan, what can you do?
Ask your pharmacist if he/she knows why the plan is not covering your drug.
Ask the pharmacist to send a fax to your prescribing doctor to notify him/her that the plan is not covering the drug. (The pharmacist should have a form for this purpose.)
IMMEDIATELY contact your doctor’s office to ask for help. Your doctor can help you work with the plan to get your prescription filled. Or, your doctor may choose to prescribe another type of drug that the plan will cover.
Call your local State Health Insurance Assistance Program (SHIP) if you’d like help with this: 502-266-6084 or 1-888-737-3363.
Medicare and Medicaid: Some Basic Facts
Joyce Remy
How Medicare Works
Medicare is the federally funded program that provides partial health care coverage for most Americans 65 and over and for persons who are disabled.
Medicare: Part A
Medicare Part A covers many in-patient services, including:
hospital inpatient care
up to 100 days coverage in a skilled nursing facility
hospice care for the terminally ill.
Medicare Coverage for Care in a Nursing Home
Under the current system of Medicare payment to hospitals, the hospital's incentive is to release patients as soon as they no longer need hospital services. This means that, in many cases, patients will be well enough to leave the hospital, but not well enough to return home. Medicare helps pay for the cost of care in a skilled nursing facility on a limited basis (up to 100 days) for those in this situation. Nursing home coverage is subject to these limitations:
The nursing home care must follow a period of at least three consecutive days of hospitalization and relate to the same medical condition.
The patient must require skilled nursing or rehabilitation services on a daily basis.
The patient is responsible for a co-payment charge beginning with the 21st day of care.
Remember: Medicare payment is never an option for extended or long-term care in a nursing home.
Medicare: Part B
Medicare Part B is an optional part of the Medicare program. When a person enters the Medicare program, he or she must elect whether or not to subscribe to Part B services. If a person chooses Part B coverage, there is a premium to pay, which is deducted from the person's monthly Social Security check.
Medicare Part B covers, for example:
physicians' services
certain preventive care tests and screenings
outpatient hospital services
physical and occupational therapy
speech pathology services
x-rays, laboratory charges, and other diagnostic tests
ambulance service
prosthetic devices
outpatient surgical and rehabilitation services.
The limitations on coverage through Medicare Part B include an annual deductible and a co-insurance payment based on a percent of the Medicare approved charge.
Medicare Prescription Drug Benefit
This new benefit is called "Medicare Part D." Medicare beneficiaries can now sign up for an optional Medicare drug plan or join a private health plan that includes drug coverage. Premiums average about $35/month, but vary depending on the plan you choose. Coverage, deductible, drugs covered and gaps in coverage also vary from plan to plan. Visit www.medicare.gov and select "Compare Medicare Prescription Drug Plans" for more information.
Preventive Benefits
New screening and preventive coverage has also been recently added to Medicare. People with Medicare can now take advantage of three important new benefits added to the preventive benefits package:
A one-time preventive physical exam, which must occur within the first six months of enrolling in Part B.
Cardiovascular screening
Diabetes screening
These new benefits are in addition to the preventive benefits that were already available, including cancer screening, immunizations, bone mass measurement, glaucoma screening and wellness education.
How Medicaid Works
Medicaid is a joint federal and state program to help pay the cost of medical expenses for persons with limited financial means. Coverage for low-income older adults includes:
payment of Medicare Part B premiums
payment of Medicare co-payments and deductibles, if there is no supplemental insurance
extended nursing home care.
Unlike Medicare, Medicaid is not automatically available to people based on reaching age 65 or being disabled. To qualify for Medicaid, a person's monthly income and overall resources must fall below certain specified amounts, which vary from state to state. However, certain resources are exempt or disregarded in determining eligibility.
The procedures for establishing Medicaid eligibility include:
Medicare will not cover all of your healthcare costs. Deductibles, copayments and medical charges beyond Medicare’s approved limits can add up quickly. That is why approximately 2/3 of all Medicare recipients purchase a supplemental or “Medigap” policy. “Medigap” means that these health insurance policies are intended to fill in the “gaps” in Medicare coverage—the charges you would have to pay out of pocket.
Medigap policies are standardized in most states, so you can easily compare policies and prices as you shop. (Policies are categorized as Plans A through J—from least to most comprehensive.) Insurance companies must follow federal guidelines that require each policy to include certain core benefits—such as co-payments and extended hospital coverage. For a higher premium, you can also purchase more comprehensive coverage for such items as prescription drugs, preventative care, and the amount of your deductible. In some states, you can also opt for a “Medicare Select” policy, costing less than standard policies, but including restricted choice of physicians and hospitals. Medigap coverage is parallel to Medicare—that is, if an item isn’t covered at all by Medicare, Medigap policies won’t cover it either. For example, Medigap policies do not cover long-term care, vision or dental care, hearing aids, or private duty nursing.
Before deciding to purchase a Medigap policy, it is important to assess your needs, and to decide which features are right for you. Read each policy carefully to be certain of what exactly is covered, as well as what restrictions or exclusions exist. (For example, not all plans cover home health care or emergency health care during travel in a foreign country.) For a convenient comparison of policies in your state, go to “Medigap Compare” on the U.S. government’s www.medicare.gov website.
Not everyone needs Medigap insurance. If you are enrolled in the Medicare Managed Plan, you do not need a Medigap policy, and it is illegal for a company to sell you one. If you meet (or are close to meeting) the financial criteria for Medicaid, you also do not need a supplemental policy.
Medigap policies are guaranteed renewable, which means they cannot be cancelled unless you fail to pay the premium. The best time to purchase a Medigap supplemental policy is within six months of enrolling in Medicare Part B. During this time period, you cannot be denied coverage due to preexisting health conditions. If you do not purchase a policy during the initial enrollment period, you may not be accepted later on by the company you choose—or you may have to pay more.
On the other hand, don’t be pressured into rushing as you select a plan. Weigh the benefits of various policies, and be clear on what is covered, and what the premiums will be. Work with an agent who comes highly recommended and who is familiar with Medigap policies.
For more information about Medicare supplemental insurance, or with help selecting a policy, contact your state’s Health Insurance Counseling and Advocacy Project office or State Health Insurance Assistance Program. These agencies provide free, confidential advice to Medicare beneficiaries and their families. You can locate your state’s insurance assistance program by calling the Eldercare Locator at 1-800-677-1116 or online at www.eldercare.gov.
Share Your Wisdom: Be a SHIP Volunteer
KIPDA
In 1990, the nationwide State Health Insurance Assistance Programs (SHIP) were launched to give a helping hand to people with Medicare in navigating the healthcare maze. Since its inception, SHIPs have become known as a trusted resource for information about Medicare and private health coverage, protection from fraud and abuse, and for consumer assistance.
The goals of the SHIP programs are:
To educate people with Medicare, their families and caregivers about health insurance coverage and benefits, consumer rights, insurance industry performance, and consumer safeguards
To provide one-to-one counseling to consumers in understanding their health insurance coverage benefits
To protect consumers from fraud, misdirected collection agencies, and unlawful or overzealous providers
To empower consumers to make informed choices about health insurance and long-term care options, affirm their rights, and bring about system changes.
What is Needed from a SHIP Volunteer?
Completing appropriate SHIP certification training and annual recertification complying with Kentucky requirements
Being able to offer counseling at either the counseling site, by telephone, or at the home of a homebound client for a minimum of four hours per month
Assisting clients with filling out forms, filing claims, and appeals
Complying with all pertinent rules and regulations set forth by the Kentucky State Health Insurance Program (SHIP)
Not active in selling insurance or have any potential financial gains from being a SHIP volunteer
Maintaining the confidentiality of our clients
In addition to counseling, SHIP needs volunteers to collate packets, be available for booths at special events, and many other activities.
If you are interested in becoming a SHIP Volunteer, please contact:
KIPDA Area Agency on Aging Michelle Wade, SHIP Coordinator 502-266-6084 or 1-888-737-3363
I Want to Volunteer! Where Do I Start?
Joyce Remy
Carol, 75, is a retired science teacher who volunteers at the local arboretum. She measures the growth of plants, monitors the pest traps, and helps visitors identify plant species.
Ralph, 80, a World War II veteran, serves as a volunteer docent at the military museum near his home. Says Ralph, “When they’re looking at our collection of vintage tanks, the kids are excited to find out I served on a tank crew in France. They ask a lot of questions!”
When Elsa, 68, retired from her job as an urban planner, she began tutoring at grade school, helping immigrant children with their reading skills. Says Elsa, “This one-to-one sharing is new to me—and I love it, and the children!”
Volunteering: A Special Kind of Involvement
As you think about creating a life that is full of meaningful interaction with other people, consider the possibility of becoming a volunteer. The need has never been greater in all communities, and volunteering is a great way to meet new friends. Many worthy organizations rely upon volunteers. Fortunately, many retirees are answering the call, serving their communities, sharing their gifts, and helping others.
Do you have a special skill you can share? Can your work experience translate into volunteer activity? Do you have specialized knowledge or expertise? Volunteering in your area of expertise is a way to keep your skills sharp and your mind challenged.
Investigate the organizations in your community that welcome volunteers and provide training for committed individuals:
hospitals
schools
community agencies (such as United Way, your senior center or public library)
parks and recreation department
churches and other faith communities
cultural groups (museums, theaters, music groups)
To find an organization that can use your help, first consider…
Your special skills
Your work experience
Special knowledge or skills you can share
Your interests
No matter what your answers, if you have the desire to give of your time and energy, volunteer opportunities await you! A good place to begin your search is your local Senior Services office. A directory of local offices can be found through The Eldercare Locator (www.eldercarelocator.gov). Just enter your location and the Eldercare Locator will in most cases give you the website address and phone number.
Another rich source of volunteer ideas is U.S. SeniorCorps, which is part of Americorps, a network of national service programs that is part of the Corporation for National and Community Service. Opportunities include the Foster Grandparents Program, Senior Companions, and the Retired Senior Volunteer Program (RSVP).
The U.S. Government's FirstGov portal website includes Public Service and Volunteerism, a directory of organizations and government agencies that seek volunteers.
Vounteermatch (www.volunteermatch.org) is a non-profit online service that matches prospective volunteers with service opportunities in their communities.
November 11 Senior Makeovers: Looking Good/Feeling Good
November 18 Lung Cancer Awareness Month
November 25 HOLIDAY—No Program
December 2 Medicare Part D: Making Wise Choices
December 9 Why Do Holidays Make Us Sad?
December 16 Be Safe on the Winter Roads
December 23 Celebrating Different Cultures
December 30 HOLIDAY—No Program
"October is National Book Month" Scramble
Joyce Remy
Reading is one of the best "brain exercises" there is! This month, make a conscious effort to replace TV watching—a more passive mental activity—by curling up with a good book. If you haven't checked out the offerings at your public library lately, you may be surprised at the resources available for older adults, including people with visual impairment. More and more online resources are also offered.
This month's puzzle contains 8 scrambled words, all having to do with books—and one more phrase having to do with reading. Click here to download and print your own copy!
(You will need the Adobe Acrobat Reader to see the puzzle. If you need to download a free version of the Acrobat Reader, click here.)
23Extra Help Paying for Medicare Part D, 12:00 p.m.- 1:30 p.m., Trimble County Senior Center, 3240 Highway 421 North, Bedford
29Daylight Savings Time Ends November
7Election Day
8KIPDA Area Agency on Aging Advisory Council, 10:00 a.m., 11520 Commonwealth Drive, Louisville
15Medicare Prescription Drug Coverage Open Enrollment Begins
December
13KIPDA Area Agency on Aging Advisory Council, 10:00 a.m., 11520 Commonwealth Drive, Louisville.
31Medicare Prescription Drug Coverage Open Enrollment Ends
If you would like meetings of your organization listed, fax meeting notices to Michelle Wade at KIPDA, (502) 266-5047. Information will be included as space permits.
Subscribe to "Seniors Digest"
If you would like to receive the Kentuckiana Regional Planning and Development Agency Seniors Digest in your e-mail each month, click here to add yourself to our e-mailing list.
Take the Rx Enrollment Check-up Today, and Get the Most Out of Your Medicare
Do you need help paying for your prescription drug coverage? Now, a Medicare prescription drug plan may be an even better deal for you if you are a Medicare beneficiary with limited income and resources. You may qualify for extra help that will make your low monthly premiums, deductibles and co-payments even lower—much lower. To get the most from this special benefit, act now.
If
How Medicare Works
Medigap policies are standardized in most states, so you can easily compare policies and prices as you shop. (Policies are categorized as Plans A through J—from least to most comprehensive.) Insurance companies must follow federal guidelines that require each policy to include certain core benefits—such as co-payments and extended hospital coverage. For a higher premium, you can also purchase more comprehensive coverage for such items as prescription drugs, preventative care, and the amount of your deductible. In some states, you can also opt for a “Medicare Select” policy, costing less than standard policies, but including restricted choice of physicians and hospitals. Medigap coverage is parallel to Medicare—that is, if an item isn’t covered at all by Medicare, Medigap policies won’t cover it either. For example, Medigap policies do not cover long-term care, vision or dental care, hearing aids, or private duty nursing.
In 1990, the nationwide State Health Insurance Assistance Programs (SHIP) were launched to give a helping hand to people with Medicare in navigating the healthcare maze. Since its inception, SHIPs have become known as a trusted resource for information about Medicare and private health coverage, protection from fraud and abuse, and for consumer assistance.
Volunteering: A Special Kind of Involvement
October 28
Reading is one of the best "brain exercises" there is! This month, make a conscious effort to replace TV watching—a more passive mental activity—by curling up with a good book. If you haven't checked out the offerings at your public library lately, you may be surprised at the resources available for older adults, including people with visual impairment. More and more online resources are also offered. 
October