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The Medicare Safety Net
"Supplemental" insurance grows in importance in Connecticut
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Business New Haven
10/16/2000
By: Linda G. Mele
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When James Tendler reached his 65th birthday earlier this year, he had no intention of retiring from Lampshades-Plus, a second-generation family business that has operated in Orange for 23 years. But he did have to make some decisions about his health insurance coverage.
Tendler says the company's other employees are his wife Carol Tendler and daughter Jill Pendergast, neither of whom is old enough to apply for Medicare. But he had to.“I wasn't interested in retiring,” Tendler says, “but the insurance plan we have wasn't for someone on Medicare.”Tendler turned to his insurance specialist Steve Glick, president of Coordinated Financial Resources in Orange and administrator of the Chamber Insurance Trust. According to Glick, the regulations governing Medicare and Medicare supplemental insurance plans have changed and anyone contemplating retirement - or anyone with an employee who will turn 65 but continue working - needs to know about the available options.
“Before, those between the ages of 65 and 70 could only earn minimal amounts of money or they were penalized,” Glick says, “so many chose not to work.”
“Today, people who don't want to retire at age 65 can keep working without a penalty, but they still have to deal with Medicare,” Glick says.
Medicare is administered by the Health Care Financing Administration (HCFA), the nation's largest health-insurance program covering more than 35 million elderly Americans and another five million younger people with disabilities. In addition to people who are 65 years of age and older, Medicare also covers some people with disabilities who are under 65 years of age and people with end-stage renal disease (defined as someone with permanent kidney failure that requires dialysis or a transplant).
There are two “parts” of Medicare: Part A is hospital insurance and Part B is medical insurance.
The original Medicare plan is available everywhere in the U.S. and is the way most people get Part A and Part B benefits. In many instances there is an additional charge for Part B benefits.
Those insured under this plan may go to any doctor, specialist or hospital that accepts Medicare. Medicare pays a defined portion of the bill and the insured must pay the balance. It's important to know that some things - such as prescription drugs and nursing-home confinements - are not covered under Medicare.
Another possible Medicare choice is a managed care plan, available on its own or through the insured's employer.
In most cases, Medicare managed care plans - like HMOs - only allow their insured to go to doctors, specialists or hospitals that are part of the plan. By law, such plans must cover all Medicare Part A and B benefits. State Department of Insurance associate examiner Richard Fisher says his department is in charge of approving Medicare supplemental policy carriers and employees can usually answer questions related to Medicare or point the caller in the right direction.
Some managed-care plans do cover such extras as prescription drugs and long-term care. It's important to ask what is and is not covered under the plan that interests you. Under these kinds of plans, the insured's costs may be lower than in the government's Medicare Plan and it may require a co-pay on certain covered items.
Fee-for-service plans are usually offered by private companies and allow those insured to go to any doctor, specialist or hospital of their choice. These plans also must cover all Medicare Part A and B benefits and some may cover extras like extra days in the hospital. The plan, not Medicare, decides what portion of the bill the insured must pay. Like other health-care plans, both Part A and Part B Medicare plans have deductibles, co-payments and surcharges for late enrollment. To find out if you have Medicare coverage you must contact the Social Security Administration or your local Social Security office to verify your Medicare Part A and Part B coverage. If you are receiving Social Security, Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B.
About three months prior to your 65th birthday or 24th month of disability, you should receive an Initial Enrollment Package that contains information about Medicare, a questionnaire and a red, white and blue Medicare card. If you want both Part A and Part B insurance, must sign your Medicare card and keep it in your wallet.
If, however, you don't want Medicare Part B coverage because you have alternate coverage, you have to put an “X” in the refusal box on the Medicare card form, sign it and return it with the card to Social Security at the address shown, after which you will receive a new Medicare card that shows you have Part A only.
Some people are not automatically enrolled in Medicare. You will need to sign up for benefits if you are eligible for Social Security or Railroad
Retirement benefits, but have not yet signed up for them; or if you have permanent kidney failure that is treated with dialysis or you have had a transplant; or you are not eligible for Premium-Free Part A; or you are a government employee who is not eligible for either Social Security or Railroad Retirement benefits.
Glick says that those who work for a company with fewer than 20 employees will have Medicare as their primary insurance carrier and the company's policy as their supplementary carrier.
Those who work for a company that has 20 or more employees are able to stay with their company's carrier as a primary policy and Medicare becomes the supplemental carrier, Glick explains.
Tendler also added long-term care insurance to his policy and made sure he signed up in time to be covered. He says he chose the policy he has now “because it covers everything and the price was right.
“I signed up as soon as I realized I had to,” Tendler says, “and I urge others who are getting ready to turn 65 to do the same. When a customer walks in you can't order what they want, you have to already have it in stock. It's the same with insurance - you can't wait until you need it to get it.”
Industry insiders affirm that too many people wait until the last possible minute to enroll and then are rushed to choose a carrier and may end up with a policy that doesn't really fit their needs. They advise everyone to talk to someone in the Human Resources department (if it's a large company), the owner or person in charge of payroll or health insurance (if it's a small company) or their insurance carrier (if they are self-employed) well in advance of the time they have to make a decision.
Claire Levine, 67, is client services manager for the Chamber Insurance Trust, which has ten employees and for which she has worked for eight years.
Levine says she also didn't wait until the last minute to find out what her options were.
“A year earlier isn't too early,” Levine says, “because it will give people ample time to find out all the options, ask questions and choose the policy that's right for them.”
Levine said the option she chose included long-term care and was very affordable.
Alex Satmary,66, general manager of the Oaklane Country Club in Orange, says his company has about 25 full-time employees and another 125 part-time and seasonal workers.
Because the company has more than 20 employees, he remained with the company policy for is main coverage and has Medicare as his supplemental coverage.
“It wasn't a big deal,” Satmary says, “but I did have to make some decisions once I turned 65.” Glick says the Chamber Insurance Trust has about 70 local chambers of commerce throughout the state that have joined together to increase their insurance-buying power, which translates into lower premiums.
According to Glick, older workers should also seriously look at long-term care and disability insurance while they're looking at Medicare coverage.
“Most of the businesses in Connecticut are small businesses,” Glick says, “and the average age of their owners is 45, one of the oldest in the country.”
“And, because many small businesses are family-owned and operated, the family members usually want or need to work past the age of 65,” Glick adds.
Any Chamber of Commerce member company is eligible to participate in the Chamber Insurance Trust's available plans. If, however, you are not a chamber member, other groups of which you are a member may have insurance as one of their member benefits.
“Whether it's for the business owner/member or for their family members,” Glick says, “there is a policy out there for everyone.”
Those already on Medicare or just enrolling can find the answer to most questions by calling the Social Security Administration or checking out the numerous online Web sites.
Don't do anything yet, however, since both major party presidential candidates promise they're going to “fix” Social Security and we all know what that means.
Helpful Internet Sites:
American Association of Homes and Service for the Aging,
www.aahsa.org/public/sh.htm
American Health Care Association,
www.acha.org/info/pubthink.htm
Health Care Financing Administration,
www.hcfa.gov
Medicare,
www.medicare.gov
American Association of Retired Persons (AARP)
www.aarp.org/
Medicare Telephone Contacts:
Social Security Administration(SSA)
800-772-1213
Connecticut Department of Insurance(SHIP)
800-994-9422, in-state calls only or
860-424-5245
State Medicaid Office
800-842-1508, in-state calls only or
860-424-4908
CHOICES
800-994-9422
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