Medicare Explained at CV Library
Medicare’s ins and outs were explored in an event at the Castro Valley Library last Wednesday, February 26, presented by the HICAP program of the nonprofit Legal Assistance for Seniors.
HICAP is the Health Insurance Counseling and Advocacy Program. Its volunteers provide information about signing up for Medicare, the federal government’s main health care program for seniors. They also guide people through the many choices Medicare recipients need to make and defend their rights if they are denied. HICAP is part of California’s Department of Aging, with affiliates in every county.
Longtime volunteer Carol Sandoval led the small group at the library through the four main parts of Medicare and explained how they relate to Medi-Cal, the state’s health care program for people with low incomes.
People ordinarily sign up with Medicare during an initial enrollment period that starts a few months before their 65th birthday and ends a few months after. Afterward, they can change their coverage for a few months each year.
Medicare Part A is Hospital Insurance, free if you qualify for Social Security, or your spouse of 10 or more years does. It is available at a charge if you don’t. Some coverage is free, but some involves co-pays and deductibles.
Part B is Medical Insurance, for doctor’s visits and tests. It has a $257 annual deductible and
co-insurance is 20 percent, meaning you pay 20 percent of the doctor’s bill and Medicare pays the other 80 percent. Like Part A, it is a federal government program, and like Part A, Medicare negotiates the fees Medicare patients can be charged.
Part C is the Medicare Advantage Plans provided by private insurance companies, by law, at three different coverage levels. These combine hospital and medical insurance to replace original Medicare’s Parts A and B. In a large county like Alameda, many other plans are available, and they differ greatly in coverage, which doctors you can use, and charges. Private MediGap plans also cover some of the deductibles, co-pays and coverage gaps in Parts A and B.
To make things more daunting, the private plans change their details year-to-year, and it is well advised to consult a HICAP counselor to keep track of what’s best for you, Sandoval said. Federal Medicare is a single program and only changes with a vote of Congress, but those do happen.
Part D covers Prescription Drug Plans. Many, but not all private Medicare Advantage Plans cover this. If you have original Medicare Parts A and B, or your Medicare Advantage Plan doesn’t cover drugs, you must add a drug plan. These are offered by private providers who Medicare approves.
Standard plans have a $590 annual deductible, after which you pay 25 percent of the costs of covered drugs (Medicare covers most drugs), and you pay nothing after your out-of-pocket costs exceed $2,000.
For help with all this, Sandoval suggested you see a counselor in person and one-on-one through HICAP, particularly if you are signing up for Medicare for the first time or want to change your coverage.
There is a HICAP counselor at the Castro Valley Senior Center, 17800 Redwood Rd., on the second and fourth Mondays of each month, with 1-hour appointments you can schedule at 12 noon and 1 p.m. Call HICAP at (510) 839-0393 to schedule an appointment. The number for the Senior Center itself is (510) 881-6738.
There are other locations where you can see a HICAP counselor. One is at the San Leandro Senior Center on the first and third Tuesdays of each month at 10 a.m., 11 a.m., and 12 noon. That particular counselor speaks Japanese if that is helpful. Call HICAP at (510) 839-0393 for an appointment there or elsewhere. The senior center’s number is (510) 577-7462.
More information is available at the government’s Medicare website, www.medicare.gov, and at the website for Legal Assistance for Seniors, HICAP’s affiliate here, www.lashicap.org. You can call HICAP at (510) 839-0393 or statewide at (800) 434-0222 or call Legal Assistance for Seniors for other questions at (510) 832-3040.