November 30, 2022 Breakfast Meeting Notes

November 30, 2022 Breakfast Meeting Notes

We began with Tony’s NH Trivia, post-Thanksgiving edition.

50/50 was won by Danielle, who donated it to Tom. The card game draw went to Nancy, who drew the 6 of clubs and so the game goes on.

We had several guests. Randy and Kyle from Melcher and Prescott in Laconia and Steve from the Milford Rotary. Steve donated $200 to our annual fundraising efforts…many thanks, Steve!

Our speaker today, Lynn Warren of the Lincoln/Woodstock club, was introduced by Sharon. Lynn is a past president of Lincoln/Woodstock and the chair of their speech club committee. She is employed by State Farm and spoke to us about the complexities of Medicare

Medicare is government-provided health insurance  for people age 65 and older, as well as younger folks with particular medical conditions. It comes in two parts: Part A, which covers facilities such as hospitals and skilled nursing care, and Part B, which covers doctors and durable goods Everyone who qualifies for Medicare gets Part A at no charge but must pay for Part B. 

In addition, there are gaps in coverage and one can purchase insurance to cover those gaps. For example, Part A has a deductible of $1600/year. Hospitalization for the first 60 days incurs no copay, but from 60-90 days there is a $400/day copay, from 90-150 days there is an $800/day copay, and there is no benefit at all after 150 days. Skilled nursing care is covered for up to 100 days but one needs to be receiving care for 21 days or more before the payments of $100/day will start.Prescription drugs are not covered and so must be covered by a supplemental (Medigap) policy. Supplemental policies can also cover the difference between what the doctor charges for services and what Medicare will pay.

The premium for Part B will be $164.90 per month in 2023, but this amount varies from year to year. It also increases based on income, so high earners may find that the premiums are substantial. 

An alternative to traditional Medicare is a Medicare Advantage plan. These are private plans that replace coverage for parts A and B and that typically provide prescription coverage as well as coverage for “gap” expenses. These plans can be less costly OR more costly than traditional medicare, depending on the patient’s unique circumstances. You must first be covered by traditional Medicare before applying for an Advantage plan (the traditional plan goes away once enrolled in the Advantage plan).

Differences between traditional Medicare and Medicare Advantage Plans: Traditional Medicare allows patients to see any doctor who accepts Medicare. Medicare Advantage may use a restricted model of care such as a PPO or HMO, so if you see a doctor out of network you may get a reduced benefit or no payment at all. Some Advantage plans offer limited dental and vision benefits but these are usually not generous. (You can work with your doctor to see if your medical plan will cover these areas; for example, your yearly eye exam is probably not covered but if you mention a dry eye problem then it becomes a medical visit and is covered.) In addition, traditional Medicare will cover cost of medical treatment outside of the USA, while Advantage plans restrict coverage to the USA.

One factor affecting cost is when enrollment occurs. When a person enrolls in traditional Medicare Parts A and B, Medicare cannot cancel the policy regardless of whether the person’s health deteriorates. Medicare Advantage premiums are dependent on when the person enrolls. Most plans base the fee on the age at which the person first enrolls and do not change drastically, but there are some plans which calculate the fee based on the person’s age each year. Such plans can be tempting in the early years because they offer low premiums, but these can skyrocket over time to unacceptable levels. In addition, Advantage plans have an annual open enrollment period just like traditional medicare; if you wish to change your coverage outside of this window, you must go through a medical exam which may result in an increase in premiums.

Eligibility rules are also complex. A person needs to be enrolled in Social Security and collecting benefits in order to receive a notice of Medicare eligibility. Part A coverage is automatic, but you must get part B coverage as soon as you are eligible to avoid penalties. The enrollment period starts in the 3 months prior to your 65th birthday, continues through your birthday month, and goes on for an additional 3 months. A Medigap (supplemental) policy can start on the first day of the month in which you become eligible for Part B and up until 6 months later. After that, you must go through medical underwriting to get coverage (which could result in increased costs if you have health issues). Medicare Advantage plans and prescription drug plans have the same enrollment period as traditional Medicare. Finally, if you select an Advantage  plan, there is a period in which you can switch to a traditional Medicare supplemental plan without penalty.

In summary, Medicare is a complicated subject. You are well advised to speak to an insurance professional about your unique situation before enrolling.

Peggy thanked all those who helped to decorate the common this past weekend.

The float for the Hometown Holiday Celebration will be assembled this Friday at Sharon’s house (32 Emerson St. in Plymouth) starting at 10 am.

Steve is still looking for people to march in the parade, as well as people to help with the cook and serve and setting up and cleaning up after the bonfire. If you will be around and haven’t signed up for something yet, please contact him.

Respectfully submitted,

Lora Miller, treasurer