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Adviser guides seniors through Medicare

Staff writer

A common horror story is told about Medicare in campaign commercials. It’s scarier than “Friday the 13th” or “Nightmare on Elm Street.” It’s also non-fiction.

“Nobody wants to have a senior who is choosing between rent, a grocery bill, or medicine,” Karen Mayse said.

It’s Mayse’s job with North Central Kansas Flint Hills Agency on Aging to prevent this situation. One of her methods is counseling seniors about health insurance, trying to save them as much money as possible.

The first thing Mayse asks a senior or family member who calls is what kind of needs he or she has. A 65-year-old new retiree has a different set of options than the 90-year-old who is struggling alone at home.

A new retiree could have an active insurance plan from a former employer. Former union workers, veterans, and railroad employees usually have access to insurance plans. Mayse helps seniors find gaps in coverage and an insurance company to provide the appropriate services at a reasonable price.

An advanced Medicare plan is also an option for a new retiree. Advanced Medicare combines federal insurance with insurance provided by a company. An advantage is that gym memberships or other non-medical preventative health resources often are covered.

Yet another option is Medigap coverage. Medicare does not cover all costs, only 80 percent. Medigap, provided through many of the same insurance companies as advanced Medicare, covers the remaining 20 percent.

Mayse recommends seniors get a Medicare prescription drug plan, even if they are not currently taking prescription drugs. Once seniors are eligible, a penalty is tacked on every month it is not used. If a healthy person is suddenly diagnosed with cancer and then wants the insurance, he or she must pay the hefty co-pay for drugs plus the added cost of waiting to sign up.

“It makes a lot of people angry,” Mayse said.

Another option is a pay for fee service. In most cases, Mayse advises against this because it often requires seniors to change doctors.

Children of an elderly parent often call Mayse for advice. They tell her their father cannot take care of himself anymore or their mother can no longer go to the bathroom by herself.

Mayse said her goal was to do everything possible to allow seniors to live in their homes as long as possible. She wants to prevent a situation where seniors are forced into a nursing home when they need just a little help. In the 18-county area of the her agency serves, she points them to meals-on-wheels services and in-home caregivers who may be able to help with independent living.

If a senior needs daily nursing care for health issues, they may fall under Medicaid, government health care for low-income people. The senior may be able to pay for nursing home expenses with savings, but usually the person’s resources are exhausted within the first year.

In every case, Mayse said, programs are available to help seniors pay for gaps in Medicare or Medicaid coverage, and provide affordable medicine.

“Our goal is to let customers guide us with what they want with their life,” Mayse said.

Mayse has a connection to the project. She assisted two of her grandparents and her mother in later years.

“The reason I stayed here is that we have people out there who I get to help,” she said.

Last modified Aug. 2, 2012

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