DEAR SUN SPOTS: The Medicare open enrollment period will once again run from Oct. 15 through Dec. 7. This is an opportunity for consumers currently enrolled in a Medicare Advantage plan (Part C) or a prescription drug plan (Part D) to review their plan to ensure it still meets their needs.

Plans can change premiums, deductibles, co-pays and drug formularies on a yearly basis. The open enrollment period enables consumers to switch plans if in their best interest.

SeniorsPlus, your local Area Agency on Aging, has experienced Medicare counselors who can help with these important decisions. Appointments can be made by calling SeniorsPlus at 207-795-4010 or 1-800-427-1241.

This year, in addition to having appointments in Lewiston, we also plan on having appointments in Norway, Farmington and Wilton.

Thank you, Sun Spots, for the tremendous service you provide our communities. — Roland Bussiere, Medicare/SHIP Specialist, rbussiere@seniorsplus.org

DEAR SUN SPOTS: Good morning. I love Sun Spots and read it every day. This is my first time writing to you. I wonder if you could find an answer for me.

I am retired and I do have Medicare. I also have full coverage insurance through my husband. He pays $576.08 a month for this coverage.

What I want to know is why did my husband receive the following in a letter from the insurance company?

“You or another family member may be enrolled in a Medicare plan that would cover this claim. If you have Medicare coverage, please provide.”

This really gets to me. Why should we have Medicare pay for this when my husband has and pays for full coverage insurance?

It just seems wrong to me that this could be happening. How can the insurance company do this?

Thank you for your time and keep up the great work. — No Name via email

ANSWER: You are one of the fortunate people who have dual insurance coverage. This is a good thing for you, but it can get complicated, so you need to make sure you understand how it works.

For more information, Sun Spots once again turned to Roland, the  SeniorsPlus Medicare specialist who wrote the previous letter. Roland came up with the following from medicareinteractive.org:

“Medicare can either be primary or secondary to employer insurance. This usually depends on the size of the employer and whether or not someone is currently working. Primary insurance pays first for health care claims. Secondary insurance pays after the primary insurance for some or all of what the primary insurance did not cover. Often, secondary insurance will refuse to pay anything if the primary insurance has not paid anything.”

This means that if your husband’s insurance coverage is primary, Medicare may pick up some of the remaining balance. This has been Sun Spots’ experience in helping a family member with a similar situation.

But in order for it to work properly, Medicare and the insurance company need to know about each other, thus the letter. You or your husband should talk to his employer to find out how your employer insurance will work with Medicare.

Once you know which is primary and which is secondary, any time you see a medical professional you can let them know about both coverages. This may reduce some of your out-of-pocket expenses.

Another thing to consider is what you are paying to be covered under your husband’s insurance vs. what you might be paying for Medicare Part B. You may not need both. However, be aware that if you cancel Part B and then want to re-establish it later, you’ll pay a higher premium.

Roland noted that because your situation is complicated and he does not have all the necessary information, it is difficult to give advice. If you need help once you have all the necessary information from your husband’s employer, you can call SeniorsPlus. 

DEAR SUN SPOTS: For the person looking for informational meetings about the Affordable Care Act, DFD Russell Medical Centers is hosting a presentation at each of its locations: Monday, Sept. 30, at the Leeds Center, Tuesday, Oct. 1, at the Turner Center, and Thursday, Oct. 3, at the Monmouth Center.

The presentations will be held from 6 to 7:30 p.m. These presentations are open to the public, but space is limited. Please RSVP to reserve your seat. I can meet individually with people unable to attend the meetings. — Lisa Lemieux, certified application counselor, 524-4074, lisa.lemieux@dfdrussell 

This column is for you, our readers. It is for your questions and comments. There are only two rules: You must write to the column and sign your name (we won’t use it if you ask us not to). Please include your phone number. Letters will not be returned or answered by mail, and telephone calls will not be accepted. Your letters will appear as quickly as space allows. Address them to Sun Spots, P.O. Box 4400, Lewiston, ME 04243-4400. Inquiries can also be emailed to sunspots@sunjournal.com.

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