Assistance given for navigating Medicare

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Assistance given for navigating Medicare

When someone enrolls in Medicare, the combination of options can be confusing, and it might be difficult to match the best coverage with a budget.

On Wednesday, Grand Gateway Area Agency on Agency sent two representatives to the Tahlequah Public Library to help locals with Medicare enrollment and adjustments of coverage.

“Elders find it difficult to come to our office in Big Cabin, and we serve nine counties,” said Kay Harlan, Medicare counselor. “We want to be available, and we want to stress the importance of having their plans reviewed every year. Plans and premiums change. Some drop out of the Medicare contracts, and we add others. Right now, we are comparing plans and saving money. We’ve had some pretty big savings, ranging from $300 to $799 a year.”

Harlan said 90 Medicare enrollees had visited the traveling counseling sessions in different towns over the previous 15 days, with six weeks remaining to visit five other counties.

“A gentleman came in this morning,” Harlan said. “He was self-employed, and did not realize he needed to contact Medicare or Social Security to have his Medicare card sent to get signed up. He should already have been on Medicare prescription coverage, but he didn’t have a Medicare number. He needs to call and get everything going so he doesn’t get a penalty for not having health coverage.”

Also assisting visitors at the library was Staci Pierce, caregiver project director for Grand Gateway AAA.

“I love to interact with the seniors,” Pierce said. “It’s good to know that we play a part in helping them. We’ve received several positive comments from people who say they couldn’t have done it without us. There can be so much paperwork that comes in the mail, and it can get confusing. They say it is good to sit down with someone one-on-one and take as much time as it requires.

While there are no limits to income or savings that disqualify someone age 65 or older from Medicare, premiums are based on income.

“It’s called your IRMAA [Income-Related Monthly Adjustment Amount],” Harlan said. “There is also Extra Help that is income based. That helps with the Part D prescription drug program. And there is the Medicare Savings Program that can help pay Part B premiums, also income-based.”

The initial enrollment period for most people is a seven-month span around the 65th birthday. It includes the month during which the birthday falls, plus three months before and three months after.

Enrollment in Medicare Part A and Part B can be done online at, by calling the Social Security Administration at 1-800-772-1213, or by visiting the local Social Security office at 2401 W. Shawnee St. in Muskogee. The office is open 9 a.m. to noon on Wednesdays, 9 a.m. to 4 p.m. other weekdays and closed weekends. The local office number is 1-877-575-5195.

Some are automatically enrolled in Part A, which is hospital insurance, and Part B medical insurance, including those already receiving Social Security benefits, or people with disabilities who are under age 65. Others must sign up.

When enrolling, there are options. A person can choose traditional Medicare with Part A and Part B coverage, or a Medicare Advantage plan, which includes A and B coverage through a private insurer approved by Medicare. Such plans are usually PPOs or HMOs. The attraction of Advantage plans is they often include dental, vision and hearing coverage, and caps on out-of-pocket expenses.

Those enrolling also decide whether to buy Part D coverage for prescriptions, and those choosing regular Medicare might qualify for supplemental “Medigap” coverage to defray expenses.

There are several other options and programs, including Programs of All-inclusive Care for the Elderly, Medication Management Therapy, Medicare Savings programs, Extra Help, the Children’s Health Insurance Program, Supplemental Security Income, and Medicare can work with VA coverage and other health plans. Whether enrolling for the first time or making a yearly assessment of coverage, people should check their eligibilities.