Medicare: Preventive care, drug benefits

2010-04-19T07:00:00Z Medicare: Preventive care, drug benefitsBy Paul Swiech | pswiech@pantagraph.com pantagraph.com

BLOOMINGTON -- Mike O'Donnell is like many older Central Illinoisans who continue to work: he has private insurance, so won't see any immediate change as a result of health care reform.

But in four years when he turns 65 and when health reform is phased in, O'Donnell -- along with other people who will be on Medicare -- will make adjustments. Generally, O'Donnell likes what he sees.

O'Donnell, 61, is a west side Bloomington resident who has dependent coverage through his wife, Maria, who works in the McLean County Circuit Clerk's office. That insurance -- through Blue Cross and Blue Shield of Illinois -- costs the O'Donnells $344.50 a month plus $11.18 a month for vision coverage and $45.60 for dental coverage.

To encourage personal responsibility for health, the plan's deductible of $1,500 is reduced when the O'Donnells get their yearly physicals and complete an online health screening.

Mike O'Donnell has high cholesterol and takes one medicine to manage it, another to promote good cholesterol and a third to help kidney and liver functions. He buys generic drugs and orders 90-day supplies to control costs.

He and his wife eat a Mediterranean diet consisting of whole grains, fruits and vegetables. He takes a brisk, 30-minute walk at least three times a week and supplements that with biking.

"When I apply for Medicare at age 65, I'll need supplemental coverage to cover costs that Medicare doesn't," said O'Donnell, who is executive director of the East Central Illinois Area Agency on Aging.

Medicare now offers an introductory physical. Beginning next year under health reform, Medicare will cover an annual physical and some preventive care, such as colonoscopies, O'Donnell said.

Medicare Part D prescription drug coverage has a coverage gap --between $2,830 and $6,440 this year -- in which Medicare enrollees must pay 100 percent of drug coverage. Under health reform beginning later this year, enrollees who hit the coverage gap will be eligible for a $250 rebate. Beginning next year, enrollees will be eligible for a 50 percent discount when they're in the coverage gap. The gap will be eliminated by 2020.

While some people have taken issue with health reform's focus on coverage for younger, healthy adults, O'Donnell countered that getting preventive care at a young age reduces the odds of costlier, emergency care later -- care that everyone pays for through higher premiums.

Clearly, health reform places more responsibility on individuals to care for their health and to be aware of health insurance options. O'Donnell thinks personal responsibility is important and said reputable Web sites (like the Henry J. Kaiser Family Foundation and the National Council on Aging) can be helpful. In addition, SHIP (Senior Health Insurance Program) volunteers will likely be trained to assist older adults, and representatives of the East Central Illinois Area Agency on Aging will be available to help.

Copyright 2015 pantagraph.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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