Amy bigger picBy Amy Rowan

Options Counselor with Region 10, Area Agency on Aging and ADRC

The Medicare system a very complex and can include Part A, Part B, Part C, Part D, supplemental plans, and advantage plans. Enrollment into this program can be overwhelming. As professionals, we spend countless hours trying to stay informed on rules and regulations. The questions are endless. There’s no one-size-fits-all for Medicare – what works for your neighbor or family member may not work for you.

Most of our Medicare-related phone calls come from people enrolling into Medicare for the first time. Many are low-income seniors trying to get help paying for prescription copays and durable medical equipment or looking for homemaking assistance. During my options counseling sessions, I often find many people are not enrolled in a program that best meets their needs. They are often enrolled in the same program for years and have not looked in to other programs or companies.  Usually I hear, “It was so confusing when I signed up. I don’t want to go through that again.”  Many times people have an advantage plan, and may be better served having a supplemental plan. Unfortunately, they have not spoken with a Medicare SHIP Counselor ever to compare Supplemental/Advantage or Prescription Plans. We find people do not switch plans even as the benefits of their plans change, and even if a different plan would better meet their needs.

Beneficiaries should revisit their prescription plans each year and compare plans side-by-side to see which plan better fits their needs. Studies have found that if people were to switch plans, they would actually save money. Each year Medicare enrollees should not only look at the cost of their plan’s premium, but should also closely examine what their maximum out-of-pocket costs could be. This includes what physicians and hospitals are in their network, which providers can be used without incurring added costs, what drugs are included in the plan’s “formulary,” and what prescriptions are covered.

Many low-income seniors qualify for the Medicare Saving Program (MSP), which pays for the Part B premium ($104.90) that comes out of their Social Security check each month. They may also qualify for the Low-Income Subsidy (LIS) program, which also qualifies them to enroll with a participating prescription insurance company for a low or no cost premium and lower copays. I have helped seniors who were qualified for the LIS program and were still paying high premiums. To see if you qualify for the MSP program by going to www.colorado.gov/PEAK, or LIS-Extra Help program http://www.ssa.gov/medicare/prescriptionhelp/.  For the people who qualify for MSP they are automatically enrolled in LIS-Extra Help program.

When people call Region 10 with Medicare questions, we often refer them to RSVP CO West, Inc. at (970) 249-9639.  They provide Medicare Counseling by state-trained and certified counselors known as State Health Insurance Assistance Program (SHIP) Counselors. These counselors can help compare prescription drug plans for clients and show the options that are available; Medicare supplemental options are discussed as well as each Medicare parts A, B, C and D.

Remember: All prescription plan changes must be completed during Open Enrollment which begins October 15th and runs through December 7.

RSVP CO West, Inc. is having an Open House on November 13th at 121 N. Park in Montrose. Counselors will be available for walk-ins to get information and counseling on Medicare Part D.