Dr. James Higgins Enlighten Benefits

Dr. James Higgins works with Darla Rufner and Megan Wiley of Enlighten Benefits to discuss Medicare options. Enlighten Benefits is a boutique brokerage firm that helps Tulsans navigate Medicare enrollment.

It’s annual enrollment season for Medicare, the federal health insurance program for those age 65 and older. There are four parts of Medicare: Part A, hospital insurance; Part B, medical insurance; Part C, Medicare Advantage plans; and Part D, prescription drug coverage. There are also supplements. Navigating this topic can be confusing, so we spoke with some local experts to find out the basics.

Here are the essentials: 

1. Dates/age requirements surrounding Medicare There are two critical enrollment periods when it comes to Medicare: the initial enrollment period and the annual open enrollment period. 

The Medicare initial enrollment periodis when individuals are first eligible for Medicare on their 65th birthday. A seven-month enrollment window to sign up for Medicare Part A and Part B starts three months before your birth month and three months after your birth month.

Note that if you are already receiving Social Security benefits, you might receive a Medicare card with A and B on it. 

“The effective date is going to be the first of the month of their 65th birthday,” says Darla Rufner, managing partner at Enlighten Benefits, a local boutique brokerage firm. “Turning 65 is a big decision-making time.” 

The Medicare annual open enrollment periodis when all people enrolled in Medicare can modify their existing health plans and prescription drug coverage for the following year to better meet their needs. 

“The Medicare Open Enrollment Period opens Oct. 15 and runs through Dec. 7,” says Kathy Jones, Medicare Assistance Program (MAP) supervisor at LIFE Senior Services. 

2. What are the tiers and supplements of Medicare? To avoid penalties and gaps in coverage, most people should sign up for Medicare Part A and Part B during the initial enrollment period.However, there are options to consider to individualize each plan. Many seniors choose to supplement their coverage with either Medigap or Medicare Advantage. 

According to aarp.com

  • Medigap, also referred to as supplements, can only be used by people enrolled in traditional Medicare. It is not a government-run program, but private insurance you can purchase to cover some or most of your out-of- pocket expenses. These are standardized by law, but the premiums vary. 
  • Medicare Advantage, also referred to as Medicare Part C, comprises a variety of private health plans that often include benefits beyond Medicare Parts A and B. 

Ray Walker, MAP director at the Oklahoma Insurance Department, offers educational resources to counsel seniors through this process. 

“Open enrollment is the time they have the option to get enrolled in an Advantage plan, which is one of the managed care plans like an HMO (health maintenance organization) or PPO (preferred provider organization), offered by a private insurance company like United, Humana or Community Care,” Walker says. 

Part D refers to prescription drug coverage. Our experts recommend reviewing it often.

“Even if beneficiaries have been satisfied with their current Part D plan, the changes each year in plan premiums, co-pays, deductibles and drug formularies make it critically important for beneficiaries to take a fresh look at their coverage options,” Jones says. 

3. What if you’re still working and under group health care coverage? “As long as you’re still working and you’re on the group insurance through your job, that is called credible coverage,” Rufner explains. “That’s going to give you another opportunity to sign up for Part B in the future.” 

4. Are there financial penalties one might receive if they don’t do certain tasks by age 65?“Many Americans are working well past the age of 65,” Walker says. “If you don’t have group health insurance through active employment and you don’t enroll in Part B, you could be subject to a penalty,” Walker says. 

According to the Social Security website, the late enrollment penalty increases your premiums by 10% for each 12-month span you could have had Part B but didn’t sign up. 

5. How has the pandemic created challenges in accomplishing these tasks?The pandemic has closed Social Security offices for most in-person visits. “It’s very challenging to do these applications over the phone or online,” says Megan Wiley, managing partner of Enlighten Benefits. 

6. What documents must I present? Rufner suggests bringing the red, white and blue Medicare card with your effective Medicare dates and a list of current medications to any meeting regarding Medicare options. 

7. Why is enrolling in this such a nightmare for some?Rufner and Wiley acknowledge that confusing literature and technology requirements make Medicare difficult to navigate. 

“I think it’s important to go to a broker so they can explain the differences in options,” Wiley says, adding that each decision has repercussions that children have to deal with as one ages. “I think knowledge is power, especially for our seniors — to break it down and explain the benefits and ramifications 10 or 20 years down the road.”

Enlighten Benefits will host two informative meetings about Medicare Advantage plans versus Medicare supplements and any other enrollment process questions from 2-4 p.m., Nov. 14 and 28, at the Tulsa Elks Lodge, 5335 S. Harvard Ave. It will cover all Medicare options, not just one company, and is free to attend. Seating is limited. Call Darla Rufner, 918-991-5844, or Megan Wiley, 918-645-9736, to attend.

Julie Richert Jones is a wife, mother, freelance writer, culinary enthusiast and gypsy soul in the heart of suburbia.

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