One of the most important decisions facing seniors every year is selecting a Medicare plan that best fits their individual health needs. As open enrollment approaches this fall, it’s important that seniors and their loved ones can confidently navigate their Medicare options and understand important differences between traditional Medicare and Medicare Advantage.
Fortunately, there are resources to help! SHIP, State Health Insurance Assistance Program, provides unbiased help to Medicare beneficiaries, their families and caregivers. SHIP counselors stand ready to be your trusted advisor, answering your questions about Medicare and helping you make an informed decision.
Q: How did you get started as a SHIP counselor?
A: I began my career with Legal Aid of the Bluegrass in 1996 when I was a student at Morehead State University. As an intern, I assisted one of our SHIP Coordinators with administrative tasks. I was later offered a full-time position and became the SHIP Coordinator in Ashland, Ky.
Q: How do you explain the difference between the two plans to seniors?
A: Medicare is a complicated benefit but one that beneficiaries must understand to get the most out of the insurance. Describing the different Medicare benefits is difficult but it is necessary to understand all four parts of Medicare and how they work together. Only then can they truly make an informed decision about what insurance option best meets their needs.
Q: What are the biggest challenges seniors face when it comes to Medicare and Medicare Advantage plans?
A: I believe that there are two big challenges when we talk about Medicare. The first is getting unbiased information to make an informed decision and the second is trying to determine which Medicare option is best. It is an overwhelming task to compare each of these plans. Medicare SHIP does provide this comparison assistance. Because we do not sell insurance and receive no compensation from an insurance company, the information that we provide is unbiased.
Our goal is to provide a list of plans that we know will cover all medications with as few restrictions as possible and also meet their medical needs.
Q: What age should seniors start thinking about their Medicare options?
A: We recommend that people begin learning about Medicare between six months to one year before they plan to enroll. For most people, that’s when you’re 64. This will allow them the proper time to fully understand the four parts of Medicare and to learn about other options that may be available to them such as retiree coverage and Medigap insurance.
Q: When is open enrollment? Tell me about the process of choosing, dropping or switching plans.
A: Medicare open enrollment begins Oct. 15 and ends Dec. 7 of each year. During this period, beneficiaries can compare their current insurance plan to those that are being offered in the new year.
However, Medicare and Medicare Advantage are much different. There are statutory changes that are made to the benefits each year and the companies that sponsor the plans are allowed to make changes to the formulary, the list of medications the plan covers, and can add restrictions to medications which delay the medication in being filled. The companies are allowed to change their network of providers, meaning that providers that accept the insurance this year may no longer accept it next year.
For these reasons, every beneficiary should compare their plans each year. During open enrollment, beneficiaries can enroll into new coverage that will begin on Jan. 1. Each year, we receive calls in January from beneficiaries that did not compare their insurance and find that their medication is no longer covered or that their doctor no longer accepts the insurance.
It is very important for people to use that time wisely and to reach out to Medicare, 1-800-MEDICARE, or to call their Medicare SHIP Program for assistance.
Q: What resources are available for seniors to learn more about their Medicare options?
A: There are several credible organizations that provide information about Medicare. We recommend Medicare’s website, www.medicare.gov.
It is worth noting that other companies have imitated this website making it very important for beneficiaries to enter the website address listed above correctly. Nearly all government websites will end with GOV. Other creditable resources include the National Council on Aging and the Medicare Rights Center.
Q: What is your message to seniors looking at Medicare and Medicare Advantage?
A: Understand all parts of Medicare before you make a decision. If you see a commercial on TV, receive information in the mail, or a phone call about Medicare, it is most likely a company wanting to sell you a policy. If their promises seem too good to be true, listen to your instincts because those promises are more than likely false. If you did not ask for an insurance company to call you, hang up the phone. Marketing violations occur daily, and the result of those violations can be catastrophic.
When in doubt, call 1-800-MEDICARE (633-4227) or find local Medicare help by visiting www.shiphelp.org.
