Hi --

I want to start by thanking you all so much for your response to my mother's passing. Your outpouring of love and support was overwhelming. I can't thank you enough.

As I hope you know, for my June 2nd radio show, I interviewed Eric Hausman who is my go-to guy for all things Medicare related. There was so much information, there wasn't time to cover all the questions on the show so I asked Eric the rest of the questions and they're here in this newsletter. Please read on . . .

ARTICLE: SOME MEDICARE ANSWERS FOR YOU

Making all the right decisions for Medicare is so important. Knowing what to do and when to do it is often the tricky part. So, in addition to the great information Eric shared on my June 2nd show (http://www.modavox.com/voiceamerica/vshow.aspx?sid=1532), here is more important information.

Barbara: My mother has Oxford AARP Medicare coverage. What is it? Doctors don't seem to like it or accept it. It denies a lot of payments. We have been told to go with straight Medicare coverage during open enrollment. Is that the same as traditional Medicare coverage?

Eric: The Oxford AARP Medicare, that's a Medicare Advantage program, probably a Medicare HMO where you would need, if you joined this plan, you would need to use their network of doctors and hospitals that participate with this plan. So it's possible that her doctor maybe doesn't participate with the plan, or it's possible that they needed prior authorization for services under the plan. You'd only be able to know for sure by contacting Oxford AARP directly. But as far as switching coverage, if she wants to go straight Medicare-that's the way some people refer to original, traditional Medicare -- and she would be able to switch during the next annual election period which runs from November 15 to December 31. She can enroll and go back to original Medicare during that time and her coverage would start the following January 1.

Barbara: How do you enroll or dis-enroll when you are changing coverage? How does my 87 year old mother who does not have computer access enroll in a different Medicare or Medigap policy? Does she write a letter? How do we ensure that the change goes through? Can the daughter enroll on her behalf?

Eric: The daughter can help her to enroll on her behalf either online by enrolling through the Medicare Web site which is www.medicare.gov. Or she can, with her mother, she can call the plan that she wants to enroll in, or call 1-800-medicare which is open 24 hours a day, 7 days a week, to do the enrollment over the phone.

Barbara: Can she have her mother there, and the daughter can dial the number then say to the person, I'm going to put my mother on the phone, she's going to say that it is okay for me to do the enrollment and then?

Eric: Absolutely, and she should because they are going to want to speak to the mother to confirm that its okay.

Barbara: And then the mother can just give the phone back to the daughter and she can do the rest of the work?

Eric: Right, that's a good idea whether she's calling the plan that she wants to enroll in, or whether she's doing that through 1-800-Medicare. As far as Medigap insurance, with the Medigap insurance, she can contact the Medigap insurer and get an application in the mail that they can complete and mail back. Or sometimes they're able to do that over the phone.

Barbara: How do we ensure that the change goes through?

Eric: You'll get a confirmation if you enroll online, you'll receive a confirmation. If you enroll by contacting the plan at 1-800-Medicare, you'll also receive a confirmation in the mail.

Barbara: The other question was can the daughter enroll on the parent's behalf and if the parent is not online, the daughter can just do it, right, as if they are the parent?

Eric: They can enroll…anyone can enroll online for someone as long as they have all of their personal information that they would need in order to complete the online enrollment.

Barbara: Can I receive a brochure at my address rather than at my mother's address? I am not Medicare eligible, but the person I spoke to on the phone at 1-800-medicare would only send the brochure to my mother's address. I didn't have the capability to print out large volumes of information by downloading it so she wanted it mailed to her.

Eric: It would only be a problem if it's her mother's personal information. Any sort of personal claim information or maybe they did a search with her medications that she uses; something like that, then they are only going to send that information to the beneficiary, to the person with Medicare. If it's just a brochure though, just a general brochure for information on Medicare coverage, she would be able to order that online or if it's not available to order online, just to download a publication.

Barbara: But is it to any address that's so long as it's not the personal information, so long as it's a brochure?

Eric: Right. It shouldn't be any problem with a brochure because anybody has access to brochures online, or by calling. What else I want to mention too, and this pertains to the last question as well, for somebody, a child that is going to be calling 1-800-Medicare on behalf of their parent, they may want to complete the-there's a form which the 1-800-Medicare uses. It's the Medicare Authorization to Disclose Personal Health Information. I'll give you the form number. It's CMS Form 10106 and you can download that from the http://www.medicare.gov/MedicareOnlineForms/PublicForms/CMS10106.pdf site and fill it out and return it to them. And this lets the person at 1-800-Medicare know that it's okay to release personal health information to an individual or an organization that's assisting the beneficiary.

Barbara: That will make it a lot easier that going to mom's house 3,000 miles away to get her to say into the phone that you can talk to them.

Eric: Absolutely and you may not want to wait to do that if you know, or if there's the potential that you're going to be helping a parent and needing access Medicare information. Fill it out and send it in now.

Barbara: Is Medigap the same as Medicare Advantage? If not, what is the difference?

Eric: Well it is different. It's really two different ways of getting your Medicare benefits. Either you can be on traditional, original Medicare, straight Medicare as someone was referring to before, in which case, it may have a retiree policy through a former employer or union that supplements Medicare; that helps fill in the gaps in Medicare coverage. Or if not, you may purchase a private Medigap plan to do so. So for instance, Medicare will pay under Medicare Part B, 80% of what they allow for doctor services and if you had a Medigap plan; it would pick up the other 20%. That's one way of getting your Medicare coverage. The other way of getting your Medicare coverage is through a private Medicare Advantage plan like the Oxford AARP that was mentioned before. In which case, for most of those plans, you would need to go through their network of doctors and hospitals that participate in the plan. And then you would get all of your Medicare benefits, your hospital coverage, your doctor's coverage, and if you have drug coverage, all through that one private plan. And they would provide all of the coverage that the original, traditional Medicare does, and they may also give some additional benefits for services that Medicare does not cover. But there's different co-sharing involved, different amount that the person with Medicare is responsible to pay out of pocket, and these Medicare Advantage plans vary from plan to plan. So you really have to look at those details to see which is the best choice for you. So it's just two different ways of getting you Medicare health care coverage.

Barbara: So the Medigap is like when you want to be able to go outside of your, outside of the doctors that you normally, in the plan. And the Medicare Advantage is more like being in a PPO.

Eric: Well the Medicare Advantage includes the Medicare HMO and Medicare PPO, (Preferred Provider Organization) plans. The Medigap insurance, with original Medicare and Medigap insurance, it gives you the greatest flexibility where you can go to most doctors, most any doctor in the country, and Medicare will pay, and then the Medigap will supplement that payment. But with the Medicare Advantage, you may be limited to their network of doctors and hospitals. With PPO plans, you can go outside of their network. But with the HMO's you're limited to their network of providers. So it depends on the individual situation.

Barbara: What are Medicare Savings Programs?

Eric: The Medicare Savings Programs are for people with Medicare with very limited income and resources/assets (although some states including New York State waive the resource limits). These programs help to pay the monthly Part B premium ($96.40), and also make people with Medicare automatically eligible for the Full Extra Help with their Medicare Part D drug costs. This means that people with Medicare on one of the Medicare Savings Program can get both Medicare Part B and a Part D drug plan for zero premium with only small co-payments - $2.40 for generics or $6.00 for brand name drugs.

The monthly income limits for 2009 are $1239 for an individual and $1660 for a couple, with resource limits of $4000 and $6000 respectively. People with Medicare with incomes above these amounts may also be able to deduct any health insurance premiums (such as a Medigap premium) they may be paying in order to qualify.

Call 1-800-MEDICARE or the local SHIP program for questions. The SHIP phone number can be found on the back of the Medicare & You Handbook, on the www.medicare.gov web site or by calling 1-800-MEDICARE.

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