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Navigating Through the Medicare Maze

Each November Virgin Islanders age of 65+ have the opportunity to make changes to their Medicare health or prescription drug coverage during Medicare’s Open Enrollment period between Nov. 15 and Dec. 31. During this 45-day period participants can opt to change plans or stay where they are for the next year.

Medicare is a complicated program and there are many things to consider before deciding on your coverage. Fortunately, in the VI, there are fewer decisions to make because we only have access to the Original Medicare program. In contrast, seniors in other areas have two additional options: Medicare Advantage and what’s known as “Other Medicare Health Plans.”

The key difference in these two types of plans is that they are not run by the government. Instead they are run by private insurance companies which are approved by and under contract with Medicare. They provide Medicare Parts A and B services, but they are permitted to charge different amounts for various services. Plans under these two categories may include extra coverage and/or drug plans for additional cost. Their rules and procedures vary from company to company and from state to state.

Under the Original Medicare program, Virgin Islanders can receive their health care from any doctor, supplier, hospital or other facility if the provider is a participant in Medicare and accepting Medicare patients. VI participants are not required to select a primary care provider nor are they required to get a referral in order to see a specialist. In most cases prescriptions are not covered under Original Medicare, but participants can join one of the two Medicare Part D prescription programs available in the territory.

As in all jurisdictions, VI Medicare participants are required to pay a deductible each year before Medicare begins its coverage. Once the deductible is paid, participants pay a co-pay and Medicare pays its agreed upon portion. There are also monthly premiums for participation in Medicare Part B which is normally deducted from the beneficiary’s Social Security check.

When choosing to stay with a current drug plan or change, there are a few things that need to be considered during the Open Enrollment period. For instance, is there a pharmacy that you prefer because it is closer to you; under the part D program are your medications included in each plan’s formulary; is there a monthly premium; how much is your co-pay under the plan; and can you reduce your costs by purchasing your medications by mail?

Many people feel that there are just too many decisions to make without someone knowledgeable helping them along the way. In the VI the local State Health Insurance Program, also known as VI SHIP has an office in each hospital on St. Croix and St. Thomas and can help seniors navigate through the maze of options available. However, you need to make an appointment by contacting the SHIP office nearest you. You can reach the St. Croix office by phone at: 772-7368; and the St. Thomas office at 714-4354.

VI SHIP/Medicare

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