Medicare 101

To help us age gracefully, Leilani Soliven, a medicare consultant, explained how best to enroll in medicare.  Due to the complexity of the medicare program and numerous options, the services of a consultant such as provided by Premier Benefit Consultants help individuals find the best fit through home appointments or educational seminars.  Premier represents four of the six healthcare insurers in Hawaii:  United Healthcare, HMSA [exclusive contract], Ohana Health Plan, and Humana (does not represent Kaiser Permanente and AlohaCare).  Clients are never charged any fees. There are multilingual speaking agents.  Leilani provided an overview of Medicare and helpful tips.
 
Medicare is a Federal healthcare system funded by taxes paid during employment and supplemented by general revenues.  The usual way to qualify is by age-- at least 65 years old.  But a person under 65 could qualify if disabled or has special conditions such as End-Stage Renal Disease (ESRD) requiring dialysis or ALS (Lou Gehrig’s).  
 
Original Medicare is the coverage provided by the government.  It consists of Part A (hospital coverage) and Part B (doctor and outpatient visits), but not drugs, dental, or other healthcare needs.  
 
The choices for additional coverage from private insurers to supplement Original Medicare include:
  • Medicare Supplement Insurance (covers some or all of  the costs not covered by Parts A and B) and/or Medicare Part D (covers prescription drugs); or
  • Medicare Advantage (Part C)-- Part C combines Part A (hospital) and Part B (doctor), and provides additional benefits; most plans also include Part D (prescription drugs).
For the lower income, Extra Help is available.  One type of Extra Help is Medicaid.  Medicaid is operated by the States. In Hawaii, the Medicaid program is called MedQuest.  Medicare would provide primary, and Medicaid supplementary secondary coverage.  Dual Special Needs Plans (D-SNPs) enroll beneficiaries who are entitled to both Medicare and Medicaid, and offer the opportunity of enhanced benefits by combining those available through the two programs.
 
People with group health policies through their employer generally do not have to sign up for Medicare when they turn 65. You can keep your employer coverage until you retire. Upon retirement, you will then have eight months within which to sign up for Medicare without facing any penalties for late enrollment.  However, most people are eligible for free Medicare Hospital Insurance (Part A) at age 65 if they have worked and paid Medicare taxes long enough, in which case you should sign up for Medicare Hospital Insurance (Part A) 3 months before your 65th birthday even if you have not retired.  Upon retirement, then initiate the other Parts.
 
To contact Leilani:  Cell:  808.478.1137; Email:  lani@pbchawaii.com.