Seniors' Medicare queries can save hundreds, experts say

Local agencies help seniors choose best options in complex plan

tgoldsmith@newsobserver.comNovember 26, 2012 

  • Resources for questions about Medicare: Medicare Phone: 800-633-4227 Online: Senior Health Insurance Information Program (NC SHIIP) Phone: 800-443-9354 Online: Senior PharmAssist in Durham Phone: 919-688-4772 Online: Medicare overview Online:

A hard look at the specifics of seniors’ Medicare plans could save many people hundreds of dollars, according to a study released during the federal program’s ongoing open enrollment period.

A study published last month in the Journal of the American Pharmacists Association showed that older people could save about $348 annually by checking with an agency such as Durham’s Senior PharmAssist while enrolling. The more than six of 10 who changed plans had a projected savings of $559.

“The plans change, so what’s good for you this year might be bad for you next year,” said Gina Upchurch, executive director of Senior PharmAssist and an author of the study.

More than 100,000 North Carolinians will turn 65 during the next year and 130,000 annually by 2025, says state demographer Jennifer Song. That means increasing numbers will be signing up for Medicare, the popular, but often hard-to-navigate federal health care program. Already, telephone hold times for advice from Medicare or other agencies can be long.

The complex, ever-changing nature of Medicare shows up in a 10 percent year-over-year increase in inquiries to the state’s Senior Health Insurance Information Program, or SHIIP. At Senior PharmAssist, which answers SHIIP calls in Durham County, calls are up 15 percent during the busy open enrollment period, which ends Dec. 7.

Knightdale resident Larry Bradbury, 69, volunteers with SHIIP, answering questions about annual choices in a complex mix of public and private Medicare programs.

“One thing that they don’t realize that it would be good for them to get their plans checked each year,” Bradbury said. “If they don’t, it just rolls over.”

Checking it twice

Marni Schribman, a spokeswoman for the state Department of Insurance, said many of the more than 10,000 calls SHIIP had received by Monday this ear concerned possible changes to recipients’ prescription drug plans, known as Medicare Part D.

“We feel that beneficiaries are learning the importance of reviewing and comparing their prescription drug plans every year as different plans can change their deductibles, copayments, formulary, and benefit structures,” Schribman said in an email. “By reviewing and comparing plans every year, beneficiaries are starting to realize that they can improve their coverage, costs or both.”

The so-called “doughnut hole” – the period during which recipients’ drug benefits are maxed out, only to pick up again – is gradually narrowing under the Affordable Care Act. It will close by 2020, as more brand and generic drugs are covered.

Medicare Advantage issues

About one in four people eligible for Medicare use a plan administered by a private company, in coverage called Medicare Advantage. These plans have come under criticism and cost-cutting by the Obama administration for costing more than traditional Medicare and sometimes confusing consumers who don’t know they are giving up their familiar Medicare cards.

“One key point of confusion has been, and remains, the Medicare Advantage terminology, as many beneficiaries confuse it with terminology associated with Medicare Supplement plans,” Schribman said. The wide variety of Medicare Advantage plans offers choices for consumers. But it can have drawbacks.

Some plans, for instance, include the Medicare D drug benefit and others do not. Also, some hospitals, doctors and skilled nursing facilities do not accept Medicare Advantage plans, so it’s important to check before choosing.

“The big warning is that some providers do not accept this coverage,” Upchurch said.

In addition to the counseling provided by volunteers such as Woodbury, SHIIP makes available staff people, especially for more difficult questions. Beneficiaries are often accompanied by adult children, siblings or friends, said Woodbury, a retired mechanical engineer.

“They are most welcome,” he said. “Sometimes the more senior citizens just don’t quite understand what’s going on.”

More ‘moving parts’

Both Medicare at the federal level and state- and county-level agencies can offer crucial help. With prescription drugs, the variables that come into play include premiums, coverage of specific drugs, price, deductibles, pharmacy choice and conditions such as whether alternate therapies must be tried first.

“People think a higher premium means a better plan, that’s not always true,” Upchurch said. “They’ve added more moving parts.”

Goldsmith: 919-829-8929

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