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If you are 65 or older, now is the time to enroll in Medicare, this country's health insurance program. Enrollment is open until Dec. 7. Nebraska Public Media’s Dale Johnson sat down with Jonathan Burlison, Administrator of Nebraska SHIP, the State Health Insurance Assistance Program, to get answers to your questions about Medicare.
Dale Johnson: Jonathan, who should be enrolling in Medicare between now and the enrollment deadline of Dec. 7.
Jonathan Burlison: Medicare's open enrollment is intended for individuals who are currently enrolled into the Medicare system. If they're enrolled in original Medicare, they're looking at their Part D prescription drug plan for next year. If they're enrolled in a Medicare Advantage plan, they're looking at that overall plan to ensure it's going to meet their needs in the next calendar year. Additionally, people who might utilize the open enrollment season currently available are those folks who may not have opted to enroll into Part D drug coverage in the past when it was first eligible, or a person who might just want to enroll into a Medicare Advantage plan itself, if they were originally in the original Medicare structure.
Johnson: If a person is covered by their employer's health insurance, should they look into Medicare?
Burlison: So it depends. You know, certainly, when a person is Medicare eligible, it is an option that they have the right to choose. When people do age into Medicare, it is encouraged to have a conversation and compare the coverage provided by the employer versus that provided by Medicare to determine if one is more effective in coverage, if one is more cost effective for the individual. Certainly, one thing to note, though, is employer size does matter. If a person has group health insurance from employment, and they have that insurance from a large employer, more than 20 people. Coordination of benefits basically states that insurance pays primary to Medicare. That's why a lot of people just take the Part A, they wait on everything else, because the group health pays first. In the event that it's a small employer, less than 20 people. A person in that situation is encouraged to enroll into Medicare because coordination of benefits states that Medicare is primary in that situation.
Johnson: Break down the four parts of Medicare.
Burlison: Medicare Part A is hospital insurance. It serves as insurance for inpatient hospital care, skilled nursing facility care, home health and hospice care. Typically it is premium free. A person has earned premium free Part A through 10 years of employment, paying their Social Security, Medicare taxes, Medicare Part B is outpatient medical insurance, essentially the insurance that gets used the most, if you will, paying for medically necessary outpatient services. So the doctors, visit the specialist, lab work, X rays, medical equipment like a CPAP machine, certainly Medicare Part B does have a premium this year. It's $174.70 per month. Medicare Part C, also known as Medicare Advantage, that is that alternative option to Original Medicare that combines Part A and Part B and typically includes Part D drug coverage. Medicare Part D, as I just said, is prescription drug coverage, and certainly does exist to cover brand name and generic drugs. Medicare Part D plans do change from year to year, so open enrollment is that opportunity to take note of those changes and make decisions for next year.
Johnson: Our conversation is timely because Medicare Advantage is in the news right now. Some hospital systems have made the decision to no longer accept Medicare Advantage plans, beginning in 2025 what dynamic does that create?
Burlison: If an individual is in a community where a hospital system has opted to no longer accept Medicare Advantage plans in the next calendar year, and that person were to remain within the advantage plan itself, they would have to access their health care through that plan's network. So potentially, maybe the local hospital doesn't accept it, but the hospital system down the highway probably would. So potentially, an individual is looking at needing to travel to access their health care, if they were to remain in the advantage plan, if a person makes that decision, I want to continue to have this relationship with this hospital, with my provider that might have that individual make that decision, I need to return to the original Medicare structure. Certainly during open enrollment season, a person has that right to return to Original Medicare effective the first of the calendar year.
Johnson: Is the ship office, a good location to get some questions answered about advantage?
Burlison: A great question. So the Nebraska ship office, what we are is federally funded by the ACL to provide unbiased Medicare education and counseling. We are state managed. We are a division of the Nebraska Department of Insurance. And again, what we exist to provide is that one-on-one education.
Johnson: Go to Doi, which is the first letters of Department of Insurance, doi.nebraska.gov, you can also go to Nebraska Public Media News, and we will have information there. Listen to this conversation again. Jonathan, you're good. I've tapped into ship many times and asked you for advice. Thank you for coming in.
Burlison: Thanks for having me.
Johnson: I'm Dale Johnson on Nebraska Public Media.