As we get older, there are two things that we find ourselves navigating through – Social Security and Medicare.
Both of them are pretty confusing, especially Medicare. Rebecca Kinney, the director of the Office of Healthcare Information and Counseling at the Administration for Community Living offers some helpful information.
Why Medicare is so hard to navigate
It’s health insurance. And health insurance is really complicated no matter how you’re getting access to that insurance, whether you’re paying for it yourself, getting it through an employer plan, or if you’re someone who’s eligible for Medicare and getting your insurance through Medicare.
It’s evolved a lot since it was originally established in 1965. It’s important for folks to take time and really sort through what is happening with their Medicare so they can make good, educated decisions on their coverage.
There are private insurance companies that contract with Medicare to provide coverage. So we’ve got lots of Medicare Advantage plans, also known as Part C, available across the country. And also the Medicare prescription drug coverage is also offered through private insurance companies.
So all of these companies are sending out information on their plans and what’s available and it can be really overwhelming for folks to understand what they’re looking at, what all this means, and how to make a decision.
That’s where one of the programs that I oversee comes into play.
It’s known as the State Health Insurance Assistance Program, also known as the SHIP. And it is a federally funded program that is available free because it is federally funded and it is also unbiased.
We are not associated with any insurance companies to really provide one-on-one assistance to Medicare and release to sort through all of those different things that they get in the mail and the questions that they might have on Medicare.
We help them navigate all of that, really understand what choices they have to make and what their options are and will help them get enrolled as well once they make a decision on a particular plan or set of plan coverage.
We can help them get enrolled in those decisions.
Medicare obstacles
The biggest thing is really that confusion and complication that we’ve been talking about. Everyone who is on Medicare is overwhelmed by that in particular.
Another big thing that we see is, you know, a lot of folks on Medicare, they’re retired, they’re living on a fixed income and they may have really limited income and assets available to help them pay for their health coverage but also their other needs, housing, food, right?
It can be hard to really figure out how can you pay, how can I afford to pay for all of these different things.
In our program, we help folks, we screen them for programs that are available to help them pay for their Medicare in particular, those premiums and copays.
If they look like they might be eligible, we’ll help them get enrolled as well.
So we’ll go through the process of helping them gather all the documents and getting the information onto the applications needed to access those benefits to help them pay for their Medicare benefits.
We also can connect them to other programs that might help them pay for those other things like food and housing. If they might be eligible to try to ensure that people are getting the access to all the benefits that they might be eligible for to help them afford their daily needs.
Recent changes to Medicare
We have a real expansion of the different private health insurance plans that are available
to help cover Medicare, those Medicare advantage and Part D plans.
The number of plans available has really grown, which is an important element for folks to navigate through. But more recently, there have been a few changes that have expanded Medicare coverage and reduced costs for Medicare beneficiaries, no matter their income.
Some examples of that include the change that happened in 2023 to reduce copay for insulin to $35, whether someone takes insulin through a pump or if they self-administer that insulin, their copay now is only $35 a month per insulin product, which in some cases has made a huge difference for folks.
Insulin has been very expensive and that reduction, it doesn’t matter what plan you’re enrolled in, your insulin copay should be no more than $35 a month for each product.
Another change is ensuring that vaccines are available free of charge to Medicare beneficiaries.
Things like the shingles vaccine and RSV vaccine are now available to Medicare beneficiaries free of charge, trying to ensure that folks get access to those preventative benefits to try to avoid those illnesses that can have extreme negative consequences for folks if they get them.
There’s also been an expansion for one of the programs that helped pay for Medicare.
Again, I was talking about this earlier, if somebody has limited income and assets and are really struggling to pay for their prescription drug costs, starting January 4th of this year, the extra help program was expanded.
Some more people are eligible for that program to help reduce the premium for part D possibly down to zero, depending on the options that are available and really reduce the copays at the pharmacy as well.
It really makes a big difference for folks who are eligible for those things.
Protecting yourself from Medicare fraud
Medicare unfortunately is a pretty big target for fraud schemes and we see a lot of things related to again, tele-health has been because the coverage for that is expanded.
We see durable medical equipment that things like wheelchairs, braces, insulin products and supplies.
They are a huge target for fraud as well and so fraudsters also use COVID as a way to try to scam people into giving them their personal information and then they would go and build Medicare for tens of thousands of dollars of things that were never provided and never received and really just pocketing that money.
It’s a real big problem and so what we try to encourage folks to do is one, be careful. Don’t give out your personal information that includes your Medicare number to anyone you don’t know. Only provide that to your healthcare providers.
Second thing, pay attention to your explanation of benefits or your Medicare summary notices that come in and show what services have been billed on your behalf and make sure those are things you actually received.
It’s a good idea to kind of keep track of all of your appointments and who you saw, which dates those types of things. Kind of use a healthcare tracker to kind of keep track of that and compare that to your explanation of benefits.
If you see something that looks funny or you don’t understand or it seems a little fishy, you can contact our program too and we will help you take a look at that and we work very closely with the Office Inspector General and Medicare.
When things look like they might have been fraud, we get them into the investigators hands as quickly as possible.
For WDHA and WMTR listeners here in New Jersey who want more information about the State Health Insurance Assistance Program, please go to shiphelp.org.
