Medicare 101: A Crash Course in St. Louis Senior Care

Recently, Bethesda communities hosted Althea West to speak to our residents about Medicare. If you missed the event, here’s a quick rundown of her helpful presentation.

Before 2006, the only decision Medicare beneficiaries had to make was, “Do I want a Medicare supplement or don’t I?” After the Medicare Modernization Act was signed by President Bush in 2003, Medicare was expanded to include prescription drugs and Medicare Advantage plans. Considering these changes, it is essential that you investigate all your options by:

• Taking inventory of your medication
• Comparing Medigap and Medicare Advantage payment options

By taking these steps, you can make an informed choice for your Medicare coverage to ensure you have the best St. Louis senior care possible.

Taking Yearly Inventories of Your Prescriptions

Many people pay much more than they should because they assume their plan for one year will be fine for the following year. For the calendar year of 2015, the State of Missouri offers 30 Part D prescription drug plans that range in cost from $15.70/month to $136.50/month. The cost of your St. Louis senior care medication depends on your plan and the types of prescriptions you receive.

Even though it’s a chore, it is important to take inventory each year to make sure the plan you are enrolled in is still the right plan for you. Not only may you have changed your prescriptions over the last year, but many times the Part D plans change their formularies or how they categorize each medication. Any of these instances could affect the cost of your Medicare.

Comparing Payment Options

When it comes to choosing your Medicare program for St. Louis senior care, consider this easy trick for understanding how payments work:

• Traditional Medicare + Medigap policy: a fee for service-based plans
• Medicare Advantage programs: a “pay as you go” system

Medicare & Medigap Policies

If you choose original Medicare and a Medicare supplement, you choose to pay the insurance company a monthly premium in exchange for your supplemental plan covering the cost of services that Medicare’s Parts A or B do not cover. There are no networks, no referrals needed, and you can go anywhere in the United States for treatment.

Medicare Advantage Programs

About 25% of Medicare beneficiaries are enrolled in a Medicare Advantage program. When one enrolls with a Medicare Advantage plan, he or she allows a private insurance company to provide Medicare benefits. Each Medicare Advantage plan has a contract with the Centers for Medicare and Medicaid Services and must offer no less than what Parts A & B coverage. Many Medicare Advantage plans do not charge a premium or offer plans with low premiums per month. Rather, seniors opt for the “pay as you go” arrangement, including copays for:

• Doctor’s office visits
• Outpatient services
• Hospital stays

However, each plan caps the maximum amount the member must pay out of pocket for each calendar year and all costs are clearly defined.

Need Help Deciding on a Medicare Plan?

Contact Althea West Today at (636) 926-8407

As a gerontologist and senior planning advisor, Althea West currently helps individuals and their families sort through the maze of Medicare choices. Her main focus is to help older adults remain as independent as possible, and gain access to all services needed to successfully achieve and maintain a quality of life. Althea is also a certified geriatric care manager and adjunct professor for University of Missouri-St. Louis. She is the founder of the nonprofit Independent Transportation Network (ITN) St. Charles – an affiliate of ITNAmerica, providing dignified transportation to older adults, and continues to serve on their Board of Directors.