Albany

Some seniors wonder if Medicare is tangled in Obamacare battle

CDPHP says they are unrelated; costs, details to be little changed for 2018
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PHOTOGRAPHER:

The annual open enrollment period is underway for Medicare recipients and the process — potentially confusing in the best of circumstances — is muddied this year by national politics.

An Albany-based health insurer said it hears from a fair number of seniors mistakenly think the efforts to undercut and roll back the Affordable Care Act — Obamacare — also will affect Medicare.

“Last year we saw it and I think we’re seeing it again this year,” said John Demers, vice president of Medicare programs for CDPHP

“They hear all this every day in the news,” he said. “Medicare constituents are saying ‘how does this affect Medicare,’ and honestly, it doesn’t.”

Health insurance for working-age adults and their families is very different from the federal program for aged and disabled Americans, and not just because of the politics involved.

“There’s nobody talking about taking Medicare away or making changes in the program,” Demers said. “When you see [the Obamacare fight] on TV … it sounds like everything is being impacted.”

CDPHP has about 42,000 members in its Medicare plans.

For 2018, their premiums will be unchanged or will decrease, Demers said.

The cost of prescription drugs remains an issue for both CDPHP and its members, and the so-called doughnut hole — the coverage gap in which the member has to pay more for drugs until hitting a spending threshold — will continue to exist in 2018. The insurer expects to eliminate it in 2020.

CDPHP is trying to move the treatment model in its Medicare plans away from caring for sick people toward keeping healthy people healthy, he said, treating them at home if necessary to avoid costly hospital admissions or readmissions.

The Medicare open enrollment period began Oct. 15 and runs through Dec. 7.

An array of regulations governs enrollment in Medicare Part A (federal hospital insurance), Part B (federal medical insurance), Part C (private-sector Advantage programs) and Part D (federal drug coverage).

Part A is free for many Americans. 

Part B and Part D are not. 

Part C is the optional private-sector replacement for Part A, Part B and, in some cases, Part D. 

Part C often covers more medical services than Part A and Part B. Depending on the specifics of the plan, the monthly Part C premium may be higher than for the federal plans, or it may by lower, or there may not even be a premium. 

For 2018, CDPHP is rolling out its first zero-dollar Medicare plan; other insurers offer them as well. These are best-suited for people who don’t expect to need a lot of health care — in return for the zero up-front cost, the out-of-pocket cost at the doctor’s office can be substantial.

Most Americans must sign up for Medicare coverage within three months of their 65th birthday to avoid penalties.

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