WellesleyWeston Magazine

FALL 2018

Launched in 2005, WellesleyWeston Magazine is a quarterly publication tailored to Wellesley and Weston residents and edited to enrich the experience of living in two of Massachusetts' most desirable communities.

Issue link: https://wellesleywestonmagazine.epubxp.com/i/1011917

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Page 125 of 207

M A S T E R F I L E / R A D I U S I M A G E S $225 a month through United Health Care (which AARP endorses) to $192 a month through Blue Cross & Blue Shield. SHINE counselors don't recommend specific insurers, but you can do the math. You can enroll and disenroll in Medigap plans at any time in Massachusetts, effective the following month. You can even switch between Core and Supplement 1 plans, if you want to roll the dice. If, for example, you are scheduled for hip surgery in November, you can avoid the $1,340 hospital deductible by waiting until October to switch to Supplement 1. Another option is Medicare Advantage, which usually comes with much lower upfront costs. There are even zero premium plans; how- ever, you'll be charged copays. You still have to sign up for Part A and Part B, and pay the Part B premiums, but Medicare Advantage is other- wise a world apart from original Medicare. It's akin to the HMO and PPO plans you likely had before you turned 65. Medicare contracts with private insurers, subsidizing the cost of the Advantage plans. A half dozen insurance companies each offer a selection of Advantage plans. The lower the premium, the higher the copays and the out-of- pocket maximum after which you no longer pay copays. The plans come with drug plans; unfortunately, prescription costs are not capped. Unlike with Medigap insurance, which you can use with any doctor who accepts Medicare, Advantage plans limit you to networks of health care providers. But an upside is that many Advantage plans offer extras like limited coverage for dental, vision, and hearing. The first step in selecting an Advantage plan is checking the company websites to make sure your doctors are covered. In many cases, you won't be reimbursed if you see a doctor who is not a member of your plan or from whom you haven't obtained a referral. Since doctors often shift in and out of plans, double check by calling the practice's billing office. Unless they offer out-of-state networks, Advantage plans will only cover you elsewhere if you have an emergency. By contrast, every doctor in the United States who takes Medicare accepts Medigap insurance, too. And some Medigap plans cover over- seas travel as well. Did you know…? n MEDICARE DOES NOT COVER ANNUAL PHYSICAL EXAMS. Rather, it offers free annual "wellness visits," in which the doctor screens you for medical risks. However, Medicare Advantage plans (see story) do cover annual physicals. n IF YOU'RE NOT ALREADY ON SOCIAL SECURITY, you will not automati- cally be notified at age 65 about signing up for Medicare. And if you fail to sign up within the seven-month window centered on your 65th birthday, you could face a penalty that will stay with you for life. n YOU DON'T NEED TO SIGN UP FOR MEDICARE so long as you or your spouse is currently working and covered by an employer plan. n THERE IS NO TRUE LIST PRICE FOR PRESCRIPTION MEDICATIONS. Each drug plan negotiates prices with drug companies and pharmacies. n DRUG COPAYS CAN CHANGE OVER THE YEAR. Under many plans, discounts for brand name and costly generic drugs don't kick in until after you've met a deductible. In addition, if the combined amount you and your drug plan pay for drugs is especially high (more than $3,750 this year), you enter the coverage gap or donut hole, and some drugs may become much more expensive. The donut hole is scheduled to be phased out over the next two years. Once you've reached $5,000 in copays, you enter the catastrophic phase, and your drug costs may drop dramatically. n SOMETIMES DRUGS ARE CHEAPER WITHOUT INSURANCE. Ask your pharmacist or check websites like goodrx.com for discounts on pre- scription drugs at local and mail order pharmacies. n THE BEST PLAN FOR YOU may not be the best one for your spouse, particularly with respect to drug coverage. 124 W e l l e s l e y W e s t o n M a g a z i n e | f a l l 2 0 1 8 Baffled by Medicare?

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