Local SHIIP counselors demystify Medicare

Counselors trained through the N.C. Department of Insurance’s Medicare and Seniors’ Health Insurance Information Program (SHIIP) can help older adults navigate the complex decisions associated with Medicare coverage. (iStock.com/Shapecharge)

As the Dec. 7 deadline for the annual Medicare open enrollment period draws nearer, older adults with Medicare coverage are encouraged to participate in what New Hanover County Senior Resource Center officials call a “Medicare checkup” to ensure proper prescription drug coverage in the coming year.

The senior center offers counseling sessions with volunteers trained by the state’s Medicare and Seniors’ Health Insurance Information Program (SHIIP) to help older adults navigate the complex decisions associated with Medicare coverage, including those made during open enrollment. 

“Having your prescription drug plan evaluated every year is really, really important,” said Steve Snyder, a volunteer SHIIP counselor at the senior center. “But it’s not a simple thing. Leaving yourself at the mercy of the insurance company is risky at best. It’s really difficult to stay a step ahead of the insurance companies.”

Older adults can enroll in a Medicare Part D plan for prescription drug coverage. Part D plans are offered by private insurance companies, and Snyder said it’s common for the coverage in Part D plans to change from year to year. That’s why he recommends all older adults research their current plan and compare it to other options during open enrollment. 

Snyder described a recent experience as a cautionary tale. He worked with a woman who takes the cancer drug Revlimid at a monthly cost of approximately $1,200 per month with coverage from her Medicare Part D insurance. When she came for an appointment with Snyder this year, they realized Revlimid was no longer covered under her current Part D plan next year. 

“Had she not come in here, she would have gone to fill this drug in January and gotten a bill for $20,000 for the month of January,” Snyder said. While he recognized this as an “extreme” example, yearly savings of up to $1,000 are common when he works with older adults to crunch the numbers and compare plans. 

Andrew Zeldin, social work supervisor at the Senior Resource Center, highlighted the SHIIP counseling sessions as an opportunity for older adults to get impartial information about Medicare coverage. 

“When they come in here, they’re getting a non-biased, objective approach to Medicare counseling because we don’t have an allegiance to insurance companies,” Zeldin said. “We’re putting the options out there.”

The senior center’s SHIIP counselors meet with older adults year-round, as taking advantage of the annual open enrollment period is one of what Snyder listed as three components of being a good Medicare consumer. The first and most important is the action a person takes when they turn 65 years old, a decision Snyder said has “lifetime consequences for you, financially and otherwise.” While the factors vary based on individual circumstances, the decision generally comes down to two options. One is original, government-administered Medicare (also known as Parts A and B) with a supplement, the latter of which helps cover the cost of medical services with an added monthly premium. 

The other is Medicare Advantage, also known as Part C, which is administered by private insurance providers. A perk of Medicare Advantage plans is no monthly premium, but these plans come with copays and network restrictions. 

“Largely, what that decision comes down to is how much risk you want to take. If you choose traditional Medicare with a supplement, you’re going to have higher out-of-pocket costs,” Snyder said. But, he added, choosing original Medicare with a supplement means that “you’ve done everything you can to control your healthcare costs for the rest of your life.”

This decision is so consequential, Snyder said, because once someone has opted out of original Medicare for a Medicare Advantage plan, they are not guaranteed coverage through a supplement if they return to original Medicare in the future – and if they are offered a supplement, the monthly cost can be adjusted based on age, health and other factors. 

“Health care is the biggest risk that seniors face in terms of their finances. That’s why their Medicare decisions are so critical,” Snyder said. 

The third component Snyder listed was avoiding Medicare scams. He said Medicare scams are often attempted over the phone, which should be a red flag for older adults.

“Medicare will never call you on the phone. If you get a call from Medicare, it’s a scam,” he said. 

SHIIP counselors at the senior center can assist older adults with all three components. Appointments can be made by calling (910) 798-6442 and leaving a message, which Snyder said will be returned within 24 hours. 

For those in need of assistance before the end of this year’s open enrollment period, Zeldin also recommended the state’s SHIIP hotline at 1-855-408-1212, where older adults can talk with a trained counselor like Snyder if they call between 8 a.m. and 5 p.m. Monday through Friday.

“It really is a great service,” Zeldin said of the state SHIIP hotline. “It’s free and unbiased, just like it is here.”