Volume 5, Issue 3, Week of January 16, 2006 

Welcome to Dear Marci, a free, weekly newsletter designed to keep you - social workers, health care providers and other professionals - in the loop about health care benefits, rights and options for older Americans and people with disabilities.   

Dear Marci is a service of the Medicare Rights Center (MRC) (www.medicarerights.org ), the nation's largest independent source of Medicare information and assistance in the United States.  Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.

This special edition of Dear Marci contains links to more information in Medicare Interactive, MRC's cutting-edge health care counseling and information tool.  Please check it out and let us know what you think.

For reprint rights, please contact AZeno@medicarerights.org.

Medicare Drug Benefit: Helping or Hurting?

Marci is collecting stories about the new Medicare drug benefit for the Medicare Rights Center’s Part D Monitoring Project. Is it working for you and your loved ones? If not, why?

Tell us about it by visiting www.medicarerights.org/partdstories.html.

Topic of the Month: Coordinating My Medicare Benefits

Marci's Mailbox

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Dear Marci,

I just began receiving Medicare. Now that I’ve retired,  I don’t have any other insurance.  While Medicare picks up the cost of certain services, I was recently hospitalized and had a difficult time paying my share of the bill.  Is there a secondary policy I can buy to help pay these expenses?

     –Anthony (Cedar Rapids, IA)
 
Dear Anthony,

Yes. There are insurance companies that sell supplemental coverage to fill certain gaps in Original Medicare. These policies, called Medigaps, help cover Medicare deductibles, coinsurance and some additional benefits.

There are 12 different standardized Medigap plans, labeled A-L (except in Massachusetts, Minnesota and Wisconsin). Not all plans are available in all areas. Medigap plans K and L are new plans that became available in 2006.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like plan J, are more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than other plans.

All Medigap plans (A-L) must include the following basic benefits:

• Hospital coinsurance coverage;
• 365 additional days of full hospital coverage;
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services;
• Full or partial coverage for the first three pints of blood you need each year.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including the following:

• Hospital deductible (plans B to L)*;
• Skilled nursing facility coinsurance (plans C to L)*;
• Part B deductible (plans C, F and J);
• Excess doctor charges (plans F, G, I and J);
• Emergency care outside the U.S. (plans C to J);
• At-home recovery (plans D, G, I and J);
• Preventive care that Medicare does not cover (plans E and J).
• Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit.

Notes:

• If you are enrolled in a Medicare private health plan, you cannot buy a Medigap policy.
• If your income is low, you may qualify for government programs that help pay your Medicare costs, so you would not need a Medigap plan.

Stay tuned next week to learn how Medicare works with other types of supplemental plans!

     –Marci

Due to high email volume, we are not currently able to accept your questions to Marci.  Please direct your questions to the Ohio Senior Health Insurance Information Program (800-686-1578).


Spotlight on Resources

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For more information about Medigaps including how to find a list of plans offered in your state, visit Medicare Interactive.

Want to find out about available Medigap options? Check out the Medicare Rights Center’s comparison chart “Medigap Plan Benefits 2006”  to see how the benefits for plans A-J—along with the two new plans K and L—match up in a side-by-side comparison.

Using the Medicare Personal Plan Finder, find out about 2006 Medicare Advantage plans and Medigap supplement policies available in your area by answering a short number of questions.

No Medigap plans will be sold with drug coverage after 2005. If you have a Medigap H, I or J policy with drug coverage, you cannot have drug coverage both through your Medigap and through the Medicare drug benefit. For more information about what happens to your current drug coverage, read the Medicare Rights Center’s “Medicare Drug Coverage 101.”

For information about government programs that can help you pay your Medicare costs, visit the Medicare Rights Center.

Call the Ohio Senior Health Insurance Information Pr ogram (800-686-1578) for more information on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare.


Health Tip of the Week

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Next time you start to feel a tickle or tightness in your throat, think twice about using just any over-the-counter cough syrup.  The American College of Chest Physicians  (ACCP) recently recommended that these products not be used. According to ACCP, the products generally do not contain enough of the active ingredient to be effective, or contain combinations of drugs that have never been proven to treat coughs. 

Even more problematic, while such elixirs may provide temporary relief, they do not treat the underlying cause of the cough.  Coughs can have numerous underlying causes, including asthma, allergies, severe heartburn, postnasal drip and bronchitis. 

A panelist involved in drafting the guidelines advises that patients see their doctors for coughs that last longer than three weeks or are accompanied by shortness of breath, which could indicate pneumonia or other life-threatening conditions.


Survey Says . . .

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Good news for people with retiree benefits!  Given the opportunity to hand over the responsibility of providing retiree drug coverage to Medicare, four in five businesses (79 percent) that now provide retiree health benefits have accepted government subsidies for continuing to provide retiree drug coverage, according to a survey of 300 of the nation’s largest private-sector employers released last month by the Kaiser Family Foundation.

Another 10 percent say that they will provide some drug coverage to supplement the new Medicare benefit, and 9 percent say that they plan to stop offering drug coverage to Medicare-eligible retirees.  More indicated they may make this decision in the future.

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Contents are © 2006 by Medicare Rights Center, 1460 Broadway, New York, NY 10036.  For reprint rights, please contact AZeno@medicarerights.org.