Jun 11, 2008 10:00 AM CST

Navigating the Medicare System

Under normal circumstances, Medicare begins automatically at age 65 if a person is receiving or has elected to receive social security at this age. Otherwise, the Medicare process begins with a visit to the local Social Security Office. This visit triggers the system that initiates the Medicare process.

Medicare has several parts: While each part will be briefly described below one of the best tools you can use for your Medicare choices is a publication named Medicare and You 2008. This tool is updated every year and may be found on the Medicare.gov website or can be requested by calling 1-800-Medicare. Once on Medicare you will automatically receive this updated book annually.

Part A of Medicare generally speaking is inpatient events such as hospitalization. If you have worked a minimum of 40 quarters (ten years) paying into the Medicare system you will receive this coverage at no premium cost to you. If you do not meet the above requirements you still may be eligible for part A of Medicare these exceptions and requirements may be found in the publication mentioned above. There is a deductable of 1024.00 for each hospital stay and a co-pay involved for stays over 60 days.

Part B of Medicare broadly speaking is outpatient services such as physician visits. This coverage is provided at a cost of 96.40 per month, it also has a deductable which in 2008 is 135.00 per year and it also involves a co-pay.

We will now skip to part D of Medicare which is the Prescription plan for Medicare beneficiaries. Currently there are over 53 different prescription plans offering varying degrees of co-pays and drug pricings. Part D is not automatically offered, but has to be specifically chosen by the Medicare beneficiary.

Part C of Medicare offers Advantage Plans. These plans are underwritten by a number of insurance companies and offer coverage in lieu of original Medicare (a person does not lose original Medicare). Rather, with an advantage plan a private company manages that care. The Part B premium of 96.40 is still required and there might be a charge in addition. There are currently a large number of Advantage plans to choose from.

There are other choices that may be added to Medicare such as Supplemental (Medigap) plans and Long Term Care plans.

If at this point you are thoroughly confused do not despair The SHINE PROGRAM is here to rescue you. SHINE stands for Serving Health Insurance Needs of Elders and is a program offered by the Department of Elder Affairs. The main site for our area is located in the Northwest Florida Area Agency on Aging and currently has 26 trained counselors to help you navigate this system. This is a free unbiased service that anyone can access by calling 850-494-7100 or toll free 1-866-531-8011 and simply asking for the SHINE department. The SHINE program has dedicated trained counselors who help with all aspects of Medicare.

A second program offered is the SUNSHINE FOR SENIORS PROGRAM this is a prescription assistance program in which trained counselors assist people in accessing medication through various sources such as manufacture’s programs. The counselors at the SHINE and SUNSHINE FOR SENIORS programs are anxious to offer services to our community so please don’t hesitate to contact the program at the above numbers if we may be of service.