Dear Alan:

As you well know, we’ve been married for many years, see each other every day and talk all the time.

However, there are still some things I don’t understand about Medicare, supplements, Advantage plans, drug plans, and all the different timelines, restrictions, “drop dead” dates, etc.

Also, why does the Medicare Supplement plan we have through CalPers cost more than if we just went directly to Blue Cross?

Your wife

Al: Very well, “she who shall be obeyed.”

Here goes…

Blue Cross has 13 different scenarios in which an individual who applies for their Medicare supplement insurance cannot be denied. The most frequent is: a person is about to turn 65, they get their Medicare A & B card, Medicare and the supplement begin the first day of their birth month and they’re very well covered medically ever after!

I won’t go into all the other scenarios, but another very common one is when someone leaves an employer group plan. For both of these scenarios one has about six months to get started. I have met people who went all the way into their 80s with only Medicare. Not a good idea because they then have to answer a bunch of medical questions and could be declined coverage.

Realize that Medicare A & B with a supplement does not cover prescription drugs. For that, a person wants to sign up for a Medicare Part D plan. There are lots of them from which to choose. For a person turning 65, the guaranteed time frame for prescription coverage is three months before birthday, the month of birthday and three months after birthday.

If you don’t get it when you are eligible, there can be a penalty. To change from one prescription plan to another the open enrollment period is each year between Oct. 15 and December. This is also the open enrollment period for Medicare Advantage plans.

Under Medicare Part C operate Advantage plans. We only have two Advantage plans in Napa: Kaiser Senior Advantage and SCAN. I usually try to explain Advantage plans by contrasting them with Medicare supplement plans.

So, dear wife, here is how our current Medicare supplement plan works: for any medical bill, the provider sends it to Medicare, Medicare pays 80 percent, then forwards it to Blue Cross, Blue Cross pays 20 percent then sends us a piece of paper saying we don’t owe anything.

With an Advantage plan like SCAN, the federal government pays the company to take on patients. Bills do not go to Medicare; they stay between the patient and the company. Typically, there are copays for office visits, lab tests, ambulance, hospital and other services up to a preset maximum out of pocket or MOOP. I’m told the MOOP for SCAN in 2016 will be $3,400. A big plus for both SCAN and Kaiser Senior Advantage is that the drug plan is included(!).

Sorry, I don’t know why we pay more for our CalPers plan.

Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511; schrette@gmail.com; or alancash@gmail.com

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