Office for the Aging

The primary objective of the Office for the Aging is to be the lead advocate for the older population of Sullivan County. All the programs sponsored or directly operated by this office are designed to give choices to older people, with the hope that through these choices they will be able to remain in their own homes and communities as long as possible.

The Office for the Aging gives priority for services to those who are frail, low income, minority, and homebound.

The Office for the Aging is made possible by the Sullivan County Legislature, New York State Office for the Aging, and the Older Americans Act.

MEDICARE ANNUAL ELECTION 2023

Fall Annual Election Period is quickly approaching! From October 15 through December 7, you can make changes as you need to your Medicare coverage such as your Part D (prescription coverage) or your Part C (Medicare Advantage Plan.) Any changes you make will take effect January 2024. If you choose to stay with your current coverage, nothing will change.

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone prescription drug plan (PDP), for those enrolled in Original Medicare, or a set of benefits included with your Medicare Advantage Plan.
Here are some questions you should ask before choosing a Part D plan:

Are my prescriptions on the plan’s formulary?

The formulary is the list of prescription drugs for which a Part D plan will help pay.

Does the plan impose any coverage restrictions, such as prior authorization, step therapy, or quantity limits?
How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need?
How much will I pay for monthly premiums and the annual deductible?
How much will I have to pay for brand-name drugs? How much for generic drugs?
Do I need to enroll in Part D if I have other creditable coverage?
Do I need to enroll in Part D if I have job-based drug coverage?

While the majority of people with Medicare get their health coverage from Original Medicare, some choose to get their benefits from a Medicare Advantage Plan (like a HMO or PPO), also known as a Medicare private health plan or Part C. MA Plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits. Remember: MA Plans may have different networks of providers, coverage rules, premiums (in addition to the Part B premium), and cost-sharing for covered services. Even plans of the same type offered by different companies may have different rules, so you should always check with a plan directly to find out how its coverage works.

Here are some questions you ask before choosing a Medicare Advantage Plan:

Providers, hospitals, and other facilities: Will I be able to use my doctors? Are they in the plan’s network? Do doctors and providers I may want to see in the future take new patients who have this plan? If my providers are not in network, will the plan still cover my visits? Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?
Access to health care: What is the service area for the plan? Do I have any coverage for care received outside the service area? Who can I choose as my primary care provider (PCP)? Does my doctor need to get approval from the plan to admit me to a hospital? Do I need a referral from my PCP to see a specialist?
Costs: What costs should I expect for my coverage (premiums, deductibles, copayments)? What is the annual maximum out-of-pocket (MOOP) cost? Note: PPOs have different out-of-pocket limits for in-network and out-of network care. If you’re considering a PPO, find out what the different out-of pocket limits are for in-network and out-of-network care. How much will I have to pay out of pocket before coverage starts (what is the deductible)? How much is my copayment for services I regularly receive, such as PCP or specialist care? How much will I pay if I visit an out-of-network provider or facility? Are there higher copays for certain types of care, such as hospital stays or home health care?
Benefits: Does the plan cover any services that Original Medicare does not (such as dental, vision, or hearing)? • Are there any rules or restrictions I should be aware of when accessing these benefits?
Prescription drugs: Does the plan cover outpatient prescription drugs? Are my prescriptions on the plan’s formulary? Does the plan impose any coverage restrictions? What costs should I expect to pay for my drug coverage (premiums, deductibles, copayments)? How much will I have to pay for brand-name drugs? How much for generic drugs? What will I pay for my drugs during the coverage gap? Will I be able to use my pharmacy? Can I get my drugs through mail order? Will the plan cover my prescriptions when I travel?

Beneficiaries should keep their Medicare card in a safe place because they’ll need it if they ever switch back to Original Medicare.

Contact the Office for the Aging and let a HIICAP counselor assist you in navigating the system and help you find the best possible coverage for your needs.

Check Out Our Monthly Newsletter!

Visit Us on Facebook!

Services

The Office for the Aging does not deny services to individuals who are unable to make a donation toward any services provided by this office. Contributions enable us to continue and expand our program to other senior citizens.