Director clues seniors in on health care options


JACKSON — Senior citizens who attended a recent program at the Melvin Cottrell Center for Senior Citizens and the Disabled heard the latest information about Medicare, prescription drug coverage and other important related topics.

“Our purpose is to provide information to people who have Medicare, or if there is a problem with Medicare we will [help you resolve that problem],” said State Health Insurance Program (SHIP) Director Deborah M. Breslin. “The SHIP program operates under a grant from the Federal Medicare Administrative Agency.”

Breslin said there are more than 375 SHIP counselors who are trained in various aspects of Medicare, Medicare supplements, long-term care, Medicare Advantage, Medicare prescription drug coverage and how other health insurance works with Medicare, as well as solving problems seniors may have with understanding Medicare.

During her presentation, Breslin covered information relating to the original Medicare Part A and original Part B programs, as well as parts C and D.

Breslin showed an original Medicare card that has been used since 1966, and shows parts A and B.

She noted there are Medicare cards issued by individual insurance companies, Aetna, Blue Cross Blue Shield of New Jersey, Humana and others, which indicate that the member has Medicare part C coverage.

Breslin noted some of the changes that will occur in 2010 in the original plan A, changes to hospital admissions, skilled nursing facility admissions, home health care and hospice care.

She noted the cost of deductibles starting in 2010 and reimbursements during benefit periods.

“One benefit period is separated from another benefit period if you have been discharged for more than 50 consecutive days,” Breslin explained. “If you go back to the hospital after the 50 days, you are now in a new benefits period.”

Breslin also explained deductibles for each benefit period, noting the deductible for 2010 will be $1,100. There will also be a daily co-payment if a hospital stay is beyond 60 days.

“In 2010 that co-payment is going to be $275 per day for each of those days up to 90. After 90 days the co-pay will be $550 for days 91 to 150,” she said. “After 150 days, Medicare stops covering in-patient hospital stays.”

At the present time the average stay for someone 55 years old is eight or nine days, she said.

Other types of coverage were explained for a patient who is transferred to a different type of facility after leaving the hospital.

Medicare Part B pays for doctor bills. There is also an annual deductible and a monthly premium.

Breslin explained that in 2010 there will be an annual deductible of $155.

“That $155 annual deductible is what Medicare allows,” she said. “Usually that increases each year.”

Breslin also compared what doctors can charge if they are in the Medicare plan or if they are in some other insurance plan, Medicare Advantage, whether it is a health maintenance organization (HMO) or a preferred provider organization (PPO).

There are also nine Medicare specialneeds plans for people with Medicare and Medicaid or for people with chronic conditions.

Breslin said Nov. 15 through Dec. 31 is the Medicare enrollment period when people can change their coverage. The new coverage begins on Jan. 1.

The speaker also compared the benefits for recipients in 2010, the gaps and the penalties for late enrollment.

Breslin suggested that seniors should not make any changes in their medical coverage unless they know what they are doing.

“Some Advantage plans that were available in 2009 will not be available in 2010 and some people have received a non-renewal notice and may be assigned to a different plan. That may not be the plan you want. Your benefits need to fit you. Benefits are individual, and spouses may have different plans,” she explained.

Each person who attended the seminar received information explaining the services provided by Medicare.

Anyone who would like additional information or would like to make an appointment to speak with a SHIP counselor can call the Ocean County Office of Senior Services at 732-929-2091, 800-668-4899 or 877-222-3737, or go to the Internet website at