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Kathy Dugan understands that people need help navigating the ruddy terrain of Medicare.
As the local director of the Statewide Health Insurance Benefit Advisory agency, Dugan answers questions about healthcare from residents throughout Eastern Washington, serving as part travel guide, part senior advocate. The free service, facilitated through the office of Aging and Long Term Care of Eastern Washington, continues to provide valuable support at a time when Medicare seems to generate more confusion than clarity.
“When people call, we’re not trying to sell them something,” Dugan said.
“We’re just trying to make things clear.”
Last week, Dugan was part of a presentation on Medicare open enrollment sponsored by the Centers for Medicare and Medicaid Services. The two-hour program was held at the Hilyard Senior Center and the Spokane Valley Senior Center last Friday. The annual open enrollment period will run from Nov. 15 through Dec. 31 for Medicare Part D and most supplements. Open enrollment for Medicare Part B and Medicare Advantage plans begins Jan. 1 and runs through March 31.
John Hammarlund, a regional administrator for CMS, told attendees at the Nov. 7 seminar that the discussions provided an opportunity “to remove some of the mystery of Medicare.
“Every year, plans, premiums and the amount of coverage changes,” Hammarlund said. “This open enrollment period is a window of time for people to enroll and change their plans.”
Each Tuesday, beginning Nov. 18, SHIBA staff and volunteers will meet with seniors at the offices of ALTCEW, 1222 N. Post, near the Spokane Arena, answering questions about open enrollment and Medicare programs. Inquiries can also be made, Monday through Friday, by calling SHIBA at 458-2509 or a toll-free Medicare informational number at 1-800-633-4227, 24 hours a day, seven days a week. Information is also available at www.medicare.gov.
“We really want people to seek out help,” Hammarlund said. “People need to do their homework and talk to someone.”
Dugan shed light on the differences between Medicare Advantage plans – administered by private companies like Secure Horizon and Asuris – and Medicare supplements, commonly accompanied by letters from A through L. Dugan warned seniors to be aware of aggressive sales pitches and to never give out their Medicare number or any bank information over the phone.
“No one from Medicare is going to call you on the phone and try to sell you a plan,” Dugan said.
There is a seven-month initial enrollment period for people who have just turned 65 and qualify for Medicare. Penalties apply for those who don’t enroll in the required time. Andrew Tartella of the CMS office described how plans differ in a variety of ways including cost, coverage, convenience and type of plan.
“That’s why it’s important to spend time looking at this,” Tartella said.
Tartella advised seniors to talk with their doctors before making any changes in insurance coverage. He added that, prior to counseling with a SHIBA representative about Medicare Part D, seniors should be clear about the medications they are taking and how often.
“Talk to your pharmacist first,” he said.
Part D covers medications, biologicals, insulin and the medical supplies required to take insulin. The coverage also contains a gap referred to as the “donut hole” in which seniors are asked to cover the cost of medications after an initial spending limit of $2,700 is reached. Coverage kicks in again after beneficiaries cover $1,650 in out-of-pocket expenses. Medicare does provide help for low-income individuals that covers the gap. There are also nine Part D plans being offered in 2009 that offer generic drug coverage through the doughnut hole.
With so much information out there, Tartella re-emphasized the importance of consulting with qualified helpers like those in the SHIBA office.
“These people are wonderful to talk to,” he said. “They’re not going to charge you anything. They’re there to help.”
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By
Craig Howard
