Sluga Reveals ‘Secrets’ Of Medicare

CASSADAGA – The last installment of Fight Cabin Fever featured at the Cassadaga Library presented Lutheran Geriatric Care Manager Janell Sluga last week.

“I like to talk about Medicare; it is a fun addiction,” she said. “I get to spend all my time with people like you.”

Sluga spoke with village residents about their insurance coverage and what it all means.

“The media always makes it sound like Medicare is like a dinosaur ready to die,” she said. “Medicare is fully funded until 2026; it isn’t going anywhere.”

The doctors are leaving health care because they are baby boomers and are retiring; not because of Medicare.

“Medicare is going to be there for you,” Sluga said. “Don’t worry about it.”

There are several different types of Medicare and they all serve a unique purpose.

Medicare A is free coverage available to individuals 65 and older or those who are disabled who have worked a sum total of 40 days in their whole life.

Medicare B is coverage available for a monthly cost of $104.90. The premium is usually taken out of the individual’s Social Security check.

“You would pay this monthly payment for the rest of your life,” Sluga said.

Medicare D is not provided by Medicare. It is prescription drug coverage with a minimum plan of a $310 deductible.

“Medicare A & B is government-run insurance,” Sluga said. “Medicare D is a confusing law which says you need drug coverage; media calls it the donut hole insurance.

“It is clear as mud and is lousy insurance,” Sluga continued. “I would like it better if it was clear and everyone bought the same policy.”

Medicare C is now known as Medicare Health Plans but referred to by some as Medicare Advantage Plans.

“You need Medicare A or B to receive Medicare Advantage,” Sluga said. “Everything is billed through this plan.”

Sluga went on to explain various terms when dealing with insurance.

HMO

HMO stands for Health Maintenance Organization and is the most popular.

“HMO is an insurance product that says you have to stay in your insurance network in order for your insurance to cover it,” she said. “You pay a set copay for various types of hospital and doctor visits.”

PPO

PPO stands for Preferred Provider Organization and is a lot like HMO.

“PPO is the same as HMO with the out of network benefit,” Sluga said. “You don’t need permission to go wherever you want to seek treatment.”

Sluga explained the downfall of PPO.

“This was a slam dunk product in 2011; people got great deals and health club membership,” she said. “However the company lost its shirt; so it is no longer available.”

PPS

PPS stands for Prospective Payment Systems.

“PPS was developed 10 years ago to allow you to see any provider in the country,” she said. “There is a flat rate for everything; you would pay the same copay for all your visits and treatments.”

Like the PPO, this too had a downfall over money.

“National companies realized they had to market to every single doctor and hospital in the country so it turned out to be a very expensive process,” she said. “Todays Options is the only one left standing that still does PPS.”

MSA

MSA stands for Medicare Savings Account and is Sluga’s favorite product. This product is only four years old.

“They prepare for you a melon savings account and prepay you your bills,” she said. “If you don’t use all the money you get to keep it.”

Sluga added Blue Cross Blue Shield offers Blue Savers, which work with the Medicare insured.

“Blue Savers pays all of your bills for the rest of your life,” she said. “In the worst year you would have to pay $1,750 and in the best year you would keep $2,000.

“We have more MSA clients than anyone else in the country,” she continued. “The best part is if your MSA goes away you get to keep all the money left in it.”

Library Board President Trudy Coulcher wanted to know why she was never told any of this information before about Medicare.

“It is like when Toyotas were new and you didn’t see many of them,” Sluga said. “After everyone started to know about Toyotas you saw them everywhere and you couldn’t tell in the parking lot which one was yours.”

Sluga explained this analogy is like Medicare.

“Now that you know about it you will start to see these ads everywhere and know what it is about,” she said.

Sluga also believes people should be nicer to their pharmacists.

“Next time you walk into a pharmacy you hug your pharmacist,” she said. “They have the most stressful job on Earth; everyone hates them; everyone blames them for coverage hikes and billing troubles.”

EPIC

Sluga brought up Elderly Pharmaceutical Insurance Coverage or EPIC and its importance.

“I love to talk about EPIC,” she said. “In order to get EPIC you have to live in NYS, be at least 65, and meet income requirements.

“It is a great product to enroll in,” she continued. “I would like to have EPIC raised because right now it is not helping out Middle American Seniors.”

EPIC started in 1985 and is still under those rates. One’s single person income has to be under $35,000 and a two-person income has to be under $50,000 in order to qualify for EPIC.

“I would like to see it raised $15,000 at least to accommodate the middle Americans,” she said. “It is sad to turn them away when they are so close to the mark; it makes me feel bad.

“They take money out of their 401K and in order to pay for their medicine,” she continued. “They are literally spending their entire retirement on medication.”