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enrollment Your Guide to Medicare & Open Enrollment A publication of

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SOUTHERN ARIZONA

OPEN

enrollment Your Guide to Medicare & Open Enrollment

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A publication of

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Growing older? Get active! �������������������������� SilverSneakers sends you in the right direction What’s new in ‘22..................................... Changes for a new year Six reasons to use a broker.................. Helping you navigate a complex process

Is dental coverage in Medicare’s future?.............................. Dr. Kildoo on the importance of dental health The ABCs (and D) of Medicare.............. The basics of how things work Guard your card........................................ Avoid fraud by protecting your information Play by the rules...................................... What’s OK and what’s not from Medicare representatives Everything I need?................................... How Medicare can help you stay in your own home Read all about it....................................... Medicare publications cover it all Need help?................................................ How you can get help paying for Medicare

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SOUTHERN ARIZONA MEDICARE UPDATE

FRANCIS WICK, President & CEO 333 W. Wilcox Dr., Suite 302, Sierra Vista, AZ, 85635 (520) 458-0200 · www.wickcommunications.com

SOUTHERN ARIZONA OPEN enrollment 2021 is produced

by the staff of Wick Communications. Cover photo by CAROLYN MAZAIKA Design & layout by GRAHAM HARRINGTON Entire contents copyright © Wick Communications 2021. No portion may be reproduced or reprinted, in whole or in part, by any means, without the written permission of the publisher.

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Growing older? Get active! SILVERSNEAKERS SENDS YOU IN THE RIGHT DIRECTION AT 65 6

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ELLEN SUSSMAN PHOTO

HUSBAND AND WIFE Rick Mathias and Jane Barnes enjoy working out together at Design Fitness with Medicare’s SilverSneakers program. “I feel like I’m healthy with these classes and it helps with balance,”

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ELLEN SUSSMAN PHOTO

BETSY ZOOLKOSKI has been attending free classes for several years with Medicare’s SilverSneakers program.

Zoolkoski says. To qualify, you need a Medicare Supplement (also known as a Medigap plan) that includes SilverSneakers. The basic program is free and offers access to gyms and fitness programs for adults 65 and older as well

as online resources that include workout videos and nutrition and fitness tips. Wuanita Powers, a Flex instructor at Design Fitness in Green Valley, leads fitness classes for seniors. On a recent morning, 15 people were exercising under her leadership with age-

appropriate routines and plenty of lively music. Husband and wife Rick Mathias, 89, and Jane Barnes, 78, take three SilverSneakers classes together. Barnes attends two more classes on her own each week. “I attend because it’s

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“IT’S A MEDICARE BENEFIT AND IT’S FOOLISH NOT TO TAKE THE CLASSES. WE COME TOGETHER AND RICK IS THE ONLY MAN. HE LOVES IT!” a Medicare benefit and exercise is important at my age,” Mathias says. “The classes help to keep my body toned.” Barnes said working out as a couple is ideal. “It’s a Medicare benefit and it’s foolish not to take the classes. We come

together and Rick is the only man. He loves it!” she says. “I like the movements and toning and the classes help with balance.” Fitness classes are designed for older adults of different fitness levels and include strength training, cardio workouts and yoga.

SILVERSNEAKERS: A HISTORY THE SILVERSNEAKERS PROGRAM was created in 1992 by Mary Swanson after helping her father recover from a heart attack. His commitment to recovery and fitness inspired her. She began envisioning a program to improve the health and well-being of seniors, laying the foundation for SilverSneakers. TODAY, there are more than 15,000 SilverSneakers fitness locations across the country.

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

What’s new in ’22? Advantage Plan premiums drop slightly, Part D drug coverage rises, and possible big changes to Original Medicare in Congress By Angelo Gentile

C

all it good news, bad news and wait-andsee news when it comes to looking at what’s new for Medicare for 2022 as open enrollment for the federal government health insurance program for Americans 65 and older begins Oct. 15 and runs through Dec. 7. First, the good news. The average premium for those enrolled in Medicare Advantage Plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, according to the Centers for Medicare and Medicaid Services (CMS). At the same time, a little bad news. Part D prescription drug coverage is rising to $33 per month, compared to $31.47 in 2021. Part D helps cover the cost of prescription drugs, including many recommended shots or vaccines. Plans that offer Medicare drug coverage—Part D—are run by private insurance companies that follow rules set by Medicare. More details on Part D

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can be found at Medicare.gov. But, beyond these monthly premium adjustments, the most significant potential changes to Original Medicare (Parts A and B) are still being considered by Congress. Part A covers hospitalization and Part B covers a variety of outpatient services such as doctor visits. Lawmakers are debating whether to add dental, vision and hearing to Original Medicare. The cost for this change, estimated at $358 billion over a decade, according to CMS, is part of President Joe Biden’s $3.5 trillion social spending package, which, as this article went to press, had yet to be approved by Congress. Along these lines, another piece of Original Medicare yet to be determined is the standard Part B monthly premium. For 2021, that amount was $148.50 (or higher depending on your income), according to Medicare.gov. The amount for 2022 could remain the same or increase. The figure is generally released in late November or early December.

SOUTHERN ARIZONA MEDICARE UPDATE

ADVANTAGE PLANS AFFECTING MORE PEOPLE The announcement of Advantage Plan premiums decreasing in cost will be welcome news to a growing number of people, CMS reported. Enrollment in Medicare Advantage Plans continues to increase. In 2022, it’s projected to reach 29.5 million people compared to 26.9 million enrolled in 2021. Medicare Advantage plans are available through Medicare Part C. Medicare Advantage Plans combine the coverage you get from Original Medicare (A and B) with additional benefits, such as routine vision coverage, hearing coverage, gym memberships in some cases, some over-thecounter (OTC) benefits, and, in most but not all cases, prescription drug coverage. According to Medicareinteractive.org, Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), contract with the federal government to offer these private plans.

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“In general, Advantage Plans are continuing to expand the range of benefits offered,” said Bernadette Harris, owner of Sierra Vista-based Sierra Medicare Solutions, which serves Cochise and Pima Counties. Advantage Plans are different from supplement plans, which are designed to work in conjunction with Original Medicare and help pay some out-of-pocket costs not covered by Original Medicare. For now, CMS has not announced any updates to supplement plans.

COVID-19 MEDICARE COVERAGE One other service area worth noting is Medicare coverage relating to COVID-19. As the pandemic continues through a second year, Medicare covers several COVID19-related items and services, including vaccines, diagnostic tests, antibody tests and monoclonal antibody treatments. Beyond the Medicare changes reported in this article, CMS has announced a number of other changes or updates for 2022. For more details on those changes, visit Medicare.gov and CMS.gov.

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

Six reasons why you should use a broker to sign up for Medicare They can help you successfully navigate a complex process at no cost to you By Angelo Gentile

S

igning up for Medicare is something you can do yourself, but, given the complex landscape of the federal government health insurance program, here are six reasons why you’ll want to seriously consider using a licensed Medicare insurance broker.

• MEDICARE IS COMPLICATED, CONFUSING AND CHANGES EVERY YEAR Are you ready to navigate Parts A, B, C, and D, and figure out monthly premiums, copays, cost shares, Advantage Plans, supplement plans, and, oh, what about prescription drug plans? “It can be confusing, plus people get a lot of information in the mail, which can add to the confusion and can be very overwhelming,” said Bernadette Harris, owner of Sierra Vista-based Sierra Medicare Solutions, which serves Cochise and Pima Counties. “Brokers offer ex-

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“BROKERS OFFER EXPERTISE. WE SPEAK MEDICARE.” Bernadette Harris, Sierra Medicare Solutions

“EVERY PERSON IS DIFFERENT, AND WHAT WE LOOK AT WITH INDIVIDUALS IS VERY PERSONAL.” Jenifer Patterson, CEO, Senior Solutions USA pertise. We speak Medicare.” “There’s a lot of confusion, particularly around Advantage Plans vs. supplements,” said Tony Waalkens,

SOUTHERN ARIZONA MEDICARE UPDATE

owner of Arizona Financial Services, which serves Cochise County and the region. Waalkens also has clients in Phoenix and throughout the

2021

state. “Brokers are well-informed and well-versed in the products and can explain the differences in plans in a way that you will under-

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Plans are insured through United Healthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. ©2021 United HealthCare Services, Inc. All rights reserved. Y0066_22SPRJ55189_C wickcommunications.com

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

stand it.” Plus, each year, changes are made to Medicare: services may be added, copays or premiums or deductibles may change, and so on. Brokers keep up with those changes.

• THERE IS NO COST FOR USING A BROKER One of the biggest miscon-

ceptions out there is that individuals have to pay for using a broker. They don’t, there is no charge, explained Conrad Christman, owner of Cochise Medicare Solutions in Sierra Vista, who has clients all over the state and is also licensed in Montana. “I often hear, ‘I want to come and see you but how much do you charge?’” Indeed, Medicare rules prohibit brokers from charging individuals. Brokers get paid com-

missions by the health plan companies. “We provide education, counseling, plan comparison and plan enrollment all at no cost to the client,” Christman said.

• TAKE ADVANTAGE OF THEIR EXPERTISE Brokers are licensed by the state and by each insurance company that offers a plan. As a result, “We know and understand the laws and rules outlined by the various

companies and government agencies,” said Jenifer Patterson, CEO of Tucson-based Senior Solutions USA, which serves Southern Arizona, including Sierra Vista and Cochise County. How important is this expertise? One example: prescription drugs. Many individuals aren’t sure about choosing a prescription drug plan under Part D or opting for an Advantage Plan

“WE PROVIDE EDUCATION, COUNSELING, PLAN COMPARISON AND PLAN ENROLLMENT ALL AT NO COST TO THE CLIENT.” Conrad Christman, Cochise Medicare Solutions

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“THERE’S A LOT OF CONFUSION, PARTICULARLY AROUND ADVANTAGE PLANS VS. SUPPLEMENTS.”

that includes prescription drugs. Brokers can help successfully navigate this process. “Prescription drugs are by far the most convoluted, hardest part of Medicare,” said Cochise Medicare’s Christman. “I see lots of people every year who are in the wrong drug plan, and when that happens it can be very expensive.”

Tony Waalkens, Arizona Financial Services

4. FIND ONE-STOP SHOPPING Using a broker means you won’t have to shop around the Medicare insurance universe on your own, said Sierra Medicare’s Harris, because brokers work with many different insurance companies and can enroll you in health plans from any of them. “We can offer an array of plans to choose from,” and, at the same time, make

sure doctors are in the plan, the appropriate prescriptions are in the plan, “and make sure it is something you can afford.”

vested interest in our clients. We care about how they are being treated and that all of their needs are being met.”

6. IT’S YOUR HEALTH AND YOUR MONEY

5. GET SERVICE AFTER ENROLLMENT Brokers are also available after enrollment. “We’re not just there to make a sale, but we’re advocates after the sale,” Harris said. “We have a

Finally, and maybe most important, choosing a Medicare plan involves two significant items: your health and your money. Make sure your plan fits your circumstances.

“Every person is different, and what we look at with individuals is very personal,” said Senior Solutions USA’s Patterson. “We look at your financial risk, and how to lower the financial risk. We look at doctors, the specific prescription drugs that are covered…We help you tailor a plan that meets your individual and unique medical and financial needs.”

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

IS DENTAL HEALTH COVERAGE IN MEDICARE’S FUTURE? By Jamie Verwys

F

or seniors, dental health is an integral part of overall health. But Medicare options are limited for dental services. The Biden Administration’s Build Back Better Act would add Medicare coverage for dental health, providing coverage for preventive and screening services as well as basic and major dental treatments starting in 2028. The Pima Council on Aging, the designated area agency on aging for Pima County, is advocating for the additional coverage and said affordable dental care is a regular concern for local seniors. President W. Mark Clark said every four years, excluding last year, they have done a community needs assessment survey. Since 2002, affordable dental care has ranked as one of the top concerns among seniors. “For people who are used to employer-sponsored dental care, when they retire they no longer have coverage,” he said. “Dental care is part of complete health care and it’s a nutrition issue for older adults. If their teeth hurt, they don't chew and don’t get good nutrition. It's a much bigger deal than a cavity or two.”

SENIOR DENTAL HEALTH Dr. Dawnie Kildoo of Den-

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tistry Smiles in Green Valley said along with not being able to eat properly, poor dental health in seniors can lead to other problems. “Probably the number one issue would be periodontal disease and that is bacteriarelated,” she said. “Some people think it's just normal to have gums recede as you get older, but it's bacterial. What happens is that it creates an inflammatory response in the gum tissue. When the inflammation goes to the rest of the body there’s a higher risk of heart attack, strokes and dementia.” Medications can also dry out the mouth and a lack of saliva can lead to tooth decay. Kildoo now screens her patients for sleep apnea when she discovered a common occurance of older patients with ground teeth. “On a lot of the older people, when they smile, their teeth are short — ground three or four millimeters over the years, which is a sleep apnea symptom,” she said. Kildoo said she is in support of the push to include dental coverage in Medicare. Her office has a membership program where seniors can get discounts on some procedures. “If it was a perio patient, it would be a different program then someone who has healthy teeth and gums,” she said. “They pay so much a

SOUTHERN ARIZONA MEDICARE UPDATE

month depending on their situation and it differs on how much they pay.” Kildoo said it’s important seniors maintain their dental health through preventive care. She said flossing is important, as well as brushing with fluoridated toothpaste. Clark said PCOA provides help to seniors in the county as they navigate their Medicare coverage. “One of the things we do here is we’re representatives of the state health insurance program,” he said. “So, we talk to people about information on plans and we have a workshop once a month, as well as a recorded version for people who are new to Medicare so people understand the complicated aspects.” PCOA is the home of the State Health Insurance Assistance Program (SHIP) for the county. The SHIP works

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DR. DAWNIE KILDOO of Dentistry Smiles in Green Valley says poor dental care can lead to big problems for the older population. with people about to turn 65 or who are already Medicare beneficiaries to provide unbiased counseling about Medicare services, as well as Medicare plans marketed by insurance providers. They do not sell or promote any kind of insurance. They’re helpline is available at 520-546-2011 and is staffed Monday through Friday from 8:30 a.m. to 5 p.m. for free consultations by appointment. PCOA is hosting a free presentation on Understanding Medicare — What you need to know — in Green Valley on Saturday, Oct. 23, at the GVR Las Campanas Center.

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Rebecca Redhouse Licensed Insurance Agent 81 W. Esperanza Blvd., Ste B Green Valley, AZ 85614 Office 520-399-2222

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Learn about upcoming events, staff and new services

Cell 520-780-8696 Fax 520-648-7006 rebeccaredhouse@yahoo.com AZ Producer LIC17138043

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

The ABCs (and D) of Medicare As Medicare’s open enrollment arrives, here’s an overview of the basics— especially geared for those newly eligible for Medicare By Angelo Gentile

G

et ready for the onslaught. If you’re 65 or older, you can expect your mailbox to be jammed over the next several weeks with multiple flyers, brochures, postcards and more that provide tons of information about Medicare and its coverage options. And let’s not even mention the barrage of TV commercials. That’s because Medicare’s annual open enrollment is Oct. 15 through Dec. 7. With open enrollment in mind, an overview of Medicare options to help sort things out makes sense—especially if you are signing up for the first time. Consider it the ABCs (and D) of Medicare.

PARTS A AND B: ORIGINAL MEDICARE A quick way to remember these two: Part A is in-patient; Part B is outpatient. Part A covers basic hospi-

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tal stays and hospital care. Part A is required. That is, everyone who is 65 is required to sign up for Part A, given that Medicare is a health insurance program funded by the federal government (no premium payment for Part A is required from the individual). Part B covers outpatient services such as doctor visits (primary care and/or specialists), lab visits, etc. Some people can delay signing up for Part B, for example, if they are still working and are covered by their employer. The standard Part B monthly premium amount in 2021 was $148.50 (or higher depending on your income), according to Medicare.gov. However, Original Medicare Parts A and B don’t cover everything. Hence, other programs exist within the Medicare landscape, such as Advantage Plans and supplement plans, to help fill in the gaps.

SOUTHERN ARIZONA MEDICARE UPDATE

PART C: MEDICARE ADVANTAGE PLANS Part C is, in a sense, a bundling of Parts A, B and D. Medicare Advantage Plans combine the coverage you get from Original Medicare (A and B) with additional benefits, such as routine vision coverage, hearing coverage, gym memberships in some cases, some over-the-counter (OTC) benefits, and pre-

2021

scription drug coverage. According to Medicareinteractive.org, Medicare Part C is not a separate benefit. Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs),

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contract with the federal government and are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare. Many different kinds of Medicare Advantage Plans are available. You will pay a monthly premium for this coverage, in addition to your Part B premium. “Over the years, the types of and the levels of benefits (available under Advantage Plans) have become more dynamic and more robust,” said Bernadette Harris, owner of Sierra Vista-based Sierra Medicare Solutions, which serves Cochise and Pima Counties. “Each carrier will have additional benefits, which may include vision, hearing, OTC benefits, telehealth options and more.”

Most, but not all, Advantage Plans include prescription drug coverage. Which leads us, next, to Part D.

PART D: PRESCRIPTION DRUG COVERAGE The prescription drug benefit, Part D, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.

SUPPLEMENT PLANS Beyond the Medicare alphabet just listed, if you don’t opt for an Advantage Plan, you can choose a supplement plan, which helps pay some out-of-pocket costs that aren’t covered by Original Medicare Parts A and

B—hence the term “supplement.” However, these supplement plans do not include prescription drug coverage. Those who opt for supplement plans then also choose a separate prescription drug plan under Part D (see section on Part D). Monthly premiums for supplement plans vary. “Supplements are designed to work in conjunction with Original Medicare,” said Jenifer Paterson, CEO of Tucson-based Senior Solutions USA, which serves Southern Arizona, including Sierra Vista and Cochise County. “Supplements pick up your cost shares that aren’t covered by Original Medicare.” Ultimately, as mentioned, Original Medicare doesn’t cover everything. Accordingly, individuals choose ei-

ther supplement plans or Advantage Plans. Essentially, beyond Original Medicare, “individuals have two options,” Patterson explained. “You can choose an Advantage Plan (under Part C), or you can go with a supplement plan and then a Part D choice for prescription drugs.” If this all sounds like a lot to sort out, it is. Therefore, it makes sense for those signing up for Medicare for the first time, as well as those reviewing their current Medicare plan, to consult with licensed Medicare sales agents and brokers (see related story on using Medicare brokers). As Patterson of Senior Solutions USA pointed out, they can help you tailor a plan that meets your individual medical and financial needs.

Get local help with your Medicare questions. I’m ANA GEORGINA SANDERS, a licensed sales agent in Nogales Arizona. When it comes to Medicare, it’s important to consider all of your options. What works well for your neighbor may not be the best fit for you. I know the ins and outs of Medicare, and I’m ready to answer your questions and help you find a plan that fits your needs. Take advantage of my knowledge and experience to: • Take the confusion out of Medicare • Get help comparing plans

• Receive one-on-one service • Make enrolling in a plan easier

I look forward to helping you explore your Medicare options so you can enroll in a plan with confidence.

It’s time to take advantage. ANA GEORGINA SANDERS Licensed Sales Agent 520-223-3601, TTY 711 agsandersinsurance@gmail.com UHCMedicareSolutions.com Sí, hablo su idioma. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. ©2021 United HealthCare Services, Inc. All rights reserved. Y0066_22SPRJ55189_C

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Guard your card AVOID FRAUD BY PROTECTING YOUR MEDICARE INFORMATION

M

edicare Open Enrollment Period (Oct. 15 – Dec. 7) brings out con artists who might try to steal your identity and commit Medicare fraud. Medicare has taken actions to make Medicare cards safer by replacing Social Security Numbers with more secure ID numbers. But even with those efforts, fraudsters may

Medicare card like it’s a credit card. Don’t give your Medicare card or Number to anyone except your doctor or people you know should have it.

YOU CAN ALSO:

still try to take advantage of you during Open Enrollment. Medicare fraud results in higher health care costs for taxpayers just like you. That’s why it’s so important to know how to protect your Medicare card and Number. What can you do to protect yourself and prevent Medicare fraud? The most important thing you can do is guard your

Know with Confidence You or Your Loved Ones are in Great Hands. 24 Hour Skilled Nursing

• Keep your Medicare Number to yourself. If you get a call from people promising you things if you give them your Medicare Number — don’t do it. This is a common Medicare scam. • Refuse any offer of money or gifts for free medical care. A common ploy of identity thieves is to say they can send you your free gift right away — they just need your Medicare Number. • Use a calendar to record all of your doctors’ appointments and any tests you get. When you check your Medicare statements, look out for any items and services listed and other details that don’t look correct. If you see a charge or service that you think is incorrect and you know the provider, call their office and ask about it. • Learn how a Medicare plan works before you join. • Stay alert for fraud during

REMEMBER THIS • Medicare will never contact you for your Medicare Number or other personal information unless you’ve given them permission in advance. • Medicare will never call you to sell you anything. • Medicare will never visit you at your home. • Medicare can’t enroll you over the phone unless you called first.

COMMITTING MEDICARE FRAUD IS ILLEGAL: REPORT IT If you suspect fraud, call 1-800-MEDICARE (1-800-6334227). TTY users can call 1-877-486-2048. If you’re in a Medicare Advantage Plan or Medicare drug plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-7723379). Learn how to protect yourself from health care fraud. Visit Medicare.gov/fraud for more information on how to help fight Medicare fraud.

Offering Medicare Plans, Medicare Supplement Plans and Affordable Care Act Plans

BERNADETTE HARRIS

Physical, Occupational and Speech Therapy

Haven of Sierra Vista 660 S. Coronado Drive Sierra Vista www.havenhg.com • (520) 459-4900

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the COVID-19 national emergency. Con artists like to take advantage of people when they’re distracted.

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Independent Insurance Broker

Call today! (973) 592-6324

sierramedicaresolutions@gmail.com • www.sierramedicaresolutions.com 500 E Fry Blvd • Haymore Plaza • Innovation Center Ste M-14 • Sierra Vista, AZ 85635

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I NEED SOME HELP LIVE CHAT Medicare.gov Live Chat is available 24 hours a day, 7 days a week, except some federal holidays. Find it at www. medicare.gov/talk-to-someone. CALL 1-800-MEDICARE For questions about your claims or other personal Medicare information, booklets or information about health plans, log in to your secure Medicare account at www.medicare.gov, or call 1-800-MEDICARE (1-800-6334227). TTY users can call 1-877-486-2048. CLAIMS AND BILLING Benefits Coordination & Recovery Center (BCRC) Medicare Secondary Payer, and who pays first. Toll-free phone: (855) 798-2627 Local TDD: (855) 797-2627 REPORTING FRAUD Toll-free phone: (800) 447-8477

ARIZONA DEPARTMENT OF INSURANCE Medigap Policies Local phone: (602) 364-2499 Toll-free phone: (800) 325-2548

The team at P3 Arizona helped me understand my Medicare options. -Mike Candrea, Former University of Arizona Head Softball Coach I always taught my players to be prepared. In turning 65, I knew Medicare was a whole new ball game. P3 Arizona helped me understand my options - including the benefits of a Medicare Advantage plan versus traditional. P3 Arizona supports seniors in getting the care they deserve.

Call us to help you navigate your AEP OPTIONS today. Learn more at (520) 462-8060 I P3Arizona.org

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Play by the rules What’s OK and what’s not from those representing Medicare plans? PEOPLE REPRESENTING MEDICARE PLANS AREN'T ALLOWED TO: • Ask for your personal information (like your Medicare, Social Security, bank account, or credit card numbers) over the phone unless it’s needed to verify membership, determine enrollment eligibility, or process an enrollment request. • Come to your home uninvited to sell or endorse anything.

• Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you. • Require you to speak to a sales agent to get information about the plan. • Offer you cash (or gifts worth more than $15) to join their plan or give you free meals during a sales pitch for a Medicare health or drug plan. • Ask you for payment over

the phone or online. The plan must send you a bill. • Tell you that they're Medicare supplement insurance (Medigap) policies. • Sell you a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare health or drug plan. • Make an appointment to tell you about their plan unless you agree. During the appointment, they can only try to sell you the products you agreed to hear about. • Talk to you about their plan in areas where you get health care like an exam room, hospital patient room, or at a pharmacy counter. • Market their plans or en-

Serving Cochise, Graham, Greenlee, and Pima Countries

roll you during an educational event like a health fair or conference. Independent agents and brokers selling plans must be licensed by the state, and the plan must tell the state which agents are selling their plans.

RULES FOR MEETING WITH AN AGENT If you're going to meet with an agent, the agent must follow all the rules for Medicare plans and some specific rules for meeting with you. During the meeting, Medicare plans and people who work with Medicare can: • Give you plan materials. • Tell you about the plan options and how to get more

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plan information. • Give you an enrollment form. • Collect your completed enrollment form. • Leave business cards for you to give to friends and family. During the meeting, Medicare plans and people who work with Medicare can't: • Charge you a fee to process your enrollment into a plan. • Steer you into a particular plan. • Communicate incorrect information about their plan type or use inappropriate statements like their plan is "the best" or "highest ranked." • Tell you about other plan options you haven't agreed to discuss, unless you specifical-

ly ask about them (to discuss these options, you need to complete a separate appointment form). • Pressure you to join their plan by saying things like "you have to join this plan or you won't have coverage next year." • Ask you to give names and phone numbers or addresses so they can sell to your friends or family. • Ask you to sign the enrollment form before you’re ready to join.

AFTER THE MEETING: • The plan will contact you to make sure you want to join and that you understand how the plan works. • The agent who helped you join the plan can call you to talk about other plan options.

Extra rules for agents selling Medicare Private-Fee-ForService (PFFS) Plans

AGENTS SELLING MEDICARE PFFS PLANS MUST: • Give you written information with a complete description of how the plan works. • Make clear that there's no guarantee that your doctor or hospital will agree to

accept the plan's terms and conditions or provide you with treatment if you join the plan. • Send you a letter if they can't reach you by phone with instructions on how to disenroll if you change your mind. • Have people available to answer any questions from you, your doctor, or other providers about the plan.

Get local help with your Medicare questions. I’m Jenifer Patterson, a licensed sales agent in Cochise County. When it comes to Medicare, it’s important to consider all of your options. What works well for your neighbor may not be the best fit for you. I know the ins and outs of Medicare, and I’m ready to answer your questions and help you find a plan that fits your needs. Take advantage of my knowledge and experience to: • Take the confusion out of Medicare • Get help comparing plans

• Receive one-on-one service • Make enrolling in a plan easier

I look forward to helping you explore your Medicare options so you can enroll in a plan with confidence.

It’s time to take advantage. Jenifer Patterson Licensed Sales Agent 520-275-3529, TTY 711 patterson.jeniferm@gmail.com https://rebrand.ly/JPMedicare Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. ©2021 United HealthCare Services, Inc. All rights reserved. Y0066_22SPRJ55189_C

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Everything I need? MEDICARE CAN KEEP YOU SAFE — AND IN YOUR HOUSE LONGER

M

edicare Part B (Medical Insurance) covers medically necessary Durable Medical Equipment if your doctor prescribes it for use in your home. The key words are medically necessary.

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DME that Medicare covers includes, but isn't limited to: • Blood sugar meters • Blood sugar test strips • Canes • Commode chairs • Continuous passive motion devices • Continuous Positive

SOUTHERN ARIZONA MEDICARE UPDATE

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Airway Pressure (CPAP) devices • Crutches • Hospital beds • Home infusion services • Infusion pumps & supplies • Lancet devices & lancets • Nebulizers & nebulizer medications • Oxygen equipment & accessories • Patient lifts • Pressure-reducing support surfaces • Suction pumps • Traction equipment • Walkers

• Wheelchairs & scooters

YOUR COSTS IN ORIGINAL MEDICARE If your supplier accepts assignment you pay 20% of the Medicare-Approved Amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment: • You may need to rent the equipment. • You may need to buy the equipment. • You may be able to

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choose whether to rent or buy the equipment. Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. Make sure your doctors and DME suppliers are enrolled in Medicare. It’s important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment (which means, they can charge

you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you. Medicare won’t pay claims for doctors or suppliers who aren’t enrolled in Medicare.

WHAT DOES DME MEAN? IT MEETS THESE CRITERIA: • Durable (can withstand repeated use) • Used for a medical reason • Not usually useful to someone who isn't sick or injured • Used in your home • Generally has an expected lifetime of at least 3 years

Get local help with your Medicare questions. I’m April Harris, a licensed sales agent in Graham and Greenly County. When it comes to Medicare, it’s important to consider all of your options. What works well for your neighbor may not be the best fit for you. I know the ins and outs of Medicare, and I’m ready to answer your questions and help you find a plan that fits your needs. Take advantage of my knowledge and experience to: • Take the confusion out of Medicare • Get help comparing plans

• Receive one-on-one service • Make enrolling in a plan easier

I look forward to helping you explore your Medicare options so you can enroll in a plan with confidence.

It’s time to take advantage. April Harris Licensed Sales Agent 928-424-2564, TTY 711 aprilforthepeople@gmail.com Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. ©2021 United HealthCare Services, Inc. All rights reserved. Y0066_22SPRJ55189_C

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Read all about it

MEDICARE PUBLICATIONS ADDRESS JUST ABOUT EVERYTHING

H

ave questions about Medicare coverage? Or about the agency’s appeals process, drug formularies or how to choose a hospital? There’s a publication for that — 100 of them (not to mention blogs, podcasts, videos and other ways to get out the message). Medicare.gov/publications is your link to all the answers, and if not, just call and talk to a human (it’s easy — 1-800-MEDICARE, 1-800-633-4227). The publications are in English and Spanish and some

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

Family Medicine Internal Medicine Pediatrics Obstetrics & Gynecology Dental General Surgery Serving Santa Cruz County Since 1980

NOGALES - 1852 N. Mastick Way

RIO RICO - 1103 Circulo Mercado

are in other languages, including Chinese and Vietnamese. They are two pages long to 300-plus. Here’s a smattering of what’s available. PATAGONIA - 101 Taylor Street

GENERAL INFORMATION • Where to Get Your Medicare Questions Answered • Are You Having Trouble Paying for Prescription Drugs? • 4 Programs That Can Help You Pay Your Medical Expenses • Welcome to Medicare Package Outside the United States • Stay Healthy: Prevent Type 2 Diabetes

TUBAC - 2239 E. Frontage Road

COVERAGE AND PAYMENT • Medicare Hospice Benefits • Getting a Second Opinion Before Surgery • Medicare and Other Health Benefits: Your Guide to Who Pays First • Medicare Coverage of Kidney Dialysis • Medicare Coverage of Skilled Nursing Facility Care • Medicare and Your Mental Health Benefits • Medicare Coverage of Ambulance Services

HEALTH CARE CHOICES • Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

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MARIPOSA NOGALES WEST - 1209 W. Target Range Road

520-281-1550 mariposachc.net

All Medical Insurance Welcome

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

• Guide to Choosing a Hospital • Your Right to Get Information About Returning to the Community (leaving nursing home care)

MEDICARE PRESCRIPTION DRUG COVERAGE • My Medicines • How Medicare Drug Plans Use Pharmacies, Formularies and Coming Coverage Rules • 4 Ways to Help Lower Your Medicare Drug Costs

MEDICARE ANNUAL ENROLLMENT PERIOD IS HERE! Begins October 15, 2021 Don’t miss the opportunity to review new plan options! When it comes to Medicare you have choices. Give us a call and we can help you. We can also help you choose the best Medicare plan for you! We also provide other resources. We can help you apply or renew for Medicare Savings Programs. These are State and Federal programs that help you pay for your Medicare part B premium. Call us to make an appointment. We have our corporate office in Nogales AZ, but we work statewide. We can assist you through phone, video call, or in person.

Don’t settle for less, give us a call today!!

(520) 287-2144 (520) 260-4764

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981 N Grand Ave • Suite 2 Nogales, AZ 85621 wickcommunications.com


RIGHTS AND PROTECTIONS

STAYING HEALTHY

• Protecting Yourself & Medicare from Fraud • How the Medicare Beneficiary Ombudsman Works for You • Medicare Appeals

• Your Guide to Medicare Preventive Services • Women and Heart Disease • Are You Up To Date on Your Preventive Services • Staying Healthy

Get local help with your Medicare questions. I’m Jenifer Patterson, a licensed sales agent in Cochise County. When it comes to Medicare, it’s important to consider all of your options. What works well for your neighbor may not be the best fit for you. I know the ins and outs of Medicare, and I’m ready to answer your questions and help you find a plan that fits your needs. Take advantage of my knowledge and experience to: • Take the confusion out of Medicare • Get help comparing plans

• Receive one-on-one service • Make enrolling in a plan easier

I look forward to helping you explore your Medicare options so you can enroll in a plan with confidence.

It’s time to take advantage. Jenifer Patterson Licensed Sales Agent 520-275-3529, TTY 711 patterson.jeniferm@gmail.com https://rebrand.ly/JPMedicare Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. ©2021 United HealthCare Services, Inc. All rights reserved. Y0066_22SPRJ55189_C

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GET ACTIVE | WHAT’S NEW | USE A BROKER | DENTAL | ABCs (and D) | PROTECT YOUR CARD | PLAY BY THE RULES | DME | READ | NEED HELP?

NEED HELP PAYING FOR MEDICARE?

W

ith the Medicare Savings Programs (MSP), you can get help from your state, paying your Medicare premiums. MSPs may also pay Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance, and copayments if you meet certain conditions. If you qualify for certain MSPs, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage. The 4 types of Medicare Savings Programs are:

QUALIFIED MEDICARE BENEFICIARY (QMB) • Individual monthly income limit - $1,094 • Married couple monthly income limit - $1,472 • Individual resource limit - $7,970 • Married couple resource limit - $11,960 Program helps pay for: • Part A premiums Part B premiums Deductibles, coinsurance, and copayments specified low income Medicare Beneficiary(SlMB) • Individual monthly income limit - $1,308 • Married couple monthly income limit - $1,762 • If you have income from working, you may qualify

for benefits even if your income is higher than the limits listed. • Individual resource limit - $7,970 • Married couple resource limit - $11,960 Program helps pay for: • Part B premiums only (may be retroactive for the previous 3 months.)

QUALIFYING INDIVIDUAL (QI) PROGRAM The QI Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources. You must apply every year for QI benefits. QI applications are granted on a first-come, firstserved basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid). • Individual monthly income limit - $1,469 • Married couple monthly income limit - $1,980 • If you have income from working, you may qualify for benefits even if your income is higher than the limits listed. • Individual resource limit - $7,970 • Married couple resource limit - $11,960 Program helps pay for: Part B premiums only

QUALIFYING DISABLED AND WORKING INDIVIDUALS (QDWI) PROGRAM The QDWI program helps pay the Part A premium. You may qualify if any of these apply to you: • You're a working disabled

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SOUTHERN ARIZONA MEDICARE UPDATE

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person under 65 • You lost your Social Security disability benefits and premiumfree Part A because you returned to work • You aren't getting medical assistance from your state • You meet the income and resource limits required by your state • Individual monthly income limit - $4,379 • Married couple monthly income limit - $5,892 • If you have income from working, you may qualify for benefits even if your income is higher than the limits listed. • Individual resource limit - $4,000 • Married couple resource limit - $6,000 Program helps pay for: • Part A premiums only Call Medicare Office to apply for this program

LOW INCOME SUBSIDY/ LIS (EXTRA HELP) Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and copayments related to Medicare Part D (prescription drug coverage). We estimate the Extra Help is worth about $5,000 per year. To qualify for Extra Help, you must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. Monthly Income to $1,595 for single person and $2,155 for a couple and Beneficial Assets to $13,110 for single person and $26,160 for a couple

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Let’s explore your Medicare plan options Discuss your specific health needs Review your plan options Walk through the enrollment process As a local Amerigroup Medicare representative, I can help you choose a plan with the benefits you deserve for the coming year.

1-on-1 help in person, online, or over the phone

Candy Garmon 1-520-237-1857, TTY: 711 AZ Lic.# 18522918 Authorized Agent candy.garmon@anthem.com Hay disponibles servicios de traducción; póngase en contacto con el plan de salud o su agente. For costs, exclusions, limitations, terms, and complete details of coverage, please contact your agent or the health plan.

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A PLAN FOR LIFE. Your life plans may change, but your health plan has options to keep you covered. With Marketplace, Medicaid and Medicare health insurance choices Arizona Complete Health offers coverage to protect your family’s health wherever life takes you.

A PLAN FOR LIFE. Marketplace Medicaid Medicare 32

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PlanForLifeAZ.com 2021

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