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Navigating the Medicare maze

News editor

The simplest thing to be said about Medicare is that when people turn 65, they qualify for it.

But it’s far from simple to understand what they qualify for, what other coverage they need, or what that extra coverage will cost.

County Department on Aging Coordinator Gayla Ratzlaff helps people nearing retirement answer those questions.

“It kind of depends what their scenario is,” Ratzloff said. “If they’re going to quit working, that’s the easy one.”

While Medicare Part A for hospital coverage is paid, a hospital stay still incurs a $1,260 deductible charge. Part B coverage for other medical expenses, such as doctor visits and therapies, carries a typical monthly premium expense of $104.90 and a $147 annual deductible.

Supplemental insurance plans are available to purchase that cover the gaps in Parts A and B. Prescription drug plan options can be numbing to consider — 28 plans are available in the Marion area, with varied premiums, co-pays, and deductibles, and estimated annual costs ranging from $187 to $1,673.

Ratzlaff said she gives workshops about Medicare options, but people often need more.

“Sometimes you have to hear it a couple of times because it’s confusing,” she said. “I’ve had people come to the class and then set up an appointment to talk to me individually.”

One tip Ratzlaff asks people to consider is to have a supplemental insurance plan in place when they start with Parts A and B. That can help them avoid the possibility of being turned down for supplemental plans due to a pre-existing condition.

“There’s a window that’s six to eight months where they don’t take into account your health conditions,” she said. “I explain the differences between different plans, I answer all their questions, and when they know that they want to do, they call the insurance company to enroll.”

People with lower incomes sometimes find the total cost of coverage to be too much of a strain on their budgets, particularly if living on a fixed income, such as Social Security.

“There are two programs that can help them out,” Ratzlaff said. “There’s a plan based on their income from the Department of Children and Families to help people pay for Part B. There’s a low-income subsidy for prescription drug programs; apply for that, and there’s a premium they don’t have to pay.”

Ratzlaff said those who can’t afford a supplemental program can apply for the state’s KanCare program, which would be secondary insurance to Medicare.

The puzzle gets more complex if a person continues to work after they turn 65, Ratzlaff said. If they are on an employer-provided health plan, it’s necessary to look at how that coverage fits with Medicare components.

“A lot of what I see is when people are going to keep working,” she said. “They’re going to sign up for Medicare Part A, and they want to know the implications of keeping working.”

When a person who continued working finally retires, options change again.

“When you get ready to quit work, you’re going to have to add these other things,” Ratzlaff said. “When you get to that point, come back and we’ll take a look at it again.”

While Ratzlaff helps people understand the financial implications of Medicare decisions and costs, she won’t give financial management advice. For those who may want such guidance, she attempts to connect them with financial advisers in the community.

For more information about Medicare or services of the Department of Aging, contact Ratzlaff by calling (620) 382-3580.

Last modified Jan. 8, 2015

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