Health insurance agency helps seniors make sense of benefits and costs
by Dorsey Griffith
When it comes to Medicare enrollment and annual adjustments of coverage, many older adults feel like they’ve fallen into a vat of alphabet soup.
With parts A, B, C and D, supplemental plans from A to N (and some with separate prescription coverage), and Medicare Advantage plans with prescription coverage, choosing the right options can mean the difference between affordable coverage and financial catastrophe for someone on a limited income.
Fortunately, Northern California seniors have a free resource in the Health Insurance Counseling and Advocacy Program (HICAP), a version of the federal State Insurance Assistance Program. HICAP is under the umbrella of Legal Services of Northern California and aids older adults in navigating the complex maze of Medicare benefits and costs.
“We are here to make you an informed consumer of Medicare benefits.”
Debbie Tyler, Regional Coordinator, Health Insurance Counseling and Advocacy Program
“We are here to make you an informed consumer of Medicare benefits,” said Debbie Tyler, one of five regional coordinators for the HICAP program, which is one of many local programs funded through Area 4 Agency on Aging (AAA4).
“We explain about Medicare, your costs, services and any ancillary services you may need to make your Medicare work,” she says.
In the simplest of terms, original Medicare includes parts A and B for medical and hospital care and covers 80 percent of costs. Part D covers drugs. Part C, also known as Medicare Advantage, is a Medicare-approved plan that offers an alternative to original Medicare for health and drug coverage. Instead of Medicare Advantage, consumers may choose a Medigap/supplemental plan. These plans’ out-of-pocket costs vary and may have additional premiums.
Regional coordinators and the HICAP team of California Department of Aging-certified volunteers are trained to help people like 94-year-old Pat Spears navigate their choices and troubleshoot when issues arise.
After years of seamless Medicare and Medicare Advantage coverage, Spears, who lives independently in a senior living community in Auburn, was informed that her physician’s medical group had pulled out of her plan. This meant she could no longer see her doctor. Panicked, she and her niece headed down to her local senior center, where she found a HICAP volunteer.
“I didn’t know where to go or what to do,” Spears said. “I wasn’t sleeping at night.”
The volunteer determined that to retain her physician, Spears would need to bridge the gap in her health insurance coverage for a few months before the regular open enrollment period. She worked on her behalf to locate and enroll her in a different Medicare Advantage Plan so she could keep her doctor and not lose coverage.
After the new coverage kicked in, she said, she fell in her kitchen and broke her arm; the new insurance covered the cost of her care.
“I really appreciate the woman who helped me,” she said. “I never will forget her.”
Tyler said patients who are on both Medi-Cal (the state’s version of Medicaid) and Medicare also face challenges. That was the case for 78-year-old Pam Austin, a CalPERS retiree and 14-year survivor of a double lung transplant.
Austin needs to take about 30 pills per day, and her co-payments for drugs can exceed $1,000 per month. HICAP first helped her obtain dual coverage from Medicare and a share-of-cost Medi-Cal program, which, together, completely covered the cost of her medications.
“Anything a senior needs, they are there to help,” said Austin, who lives in a senior living community in Roseville.
But last year, her income went up after a Social Security adjustment, and she no longer qualified for the Medi-Cal share of cost program. As a result, her out-of-pocket drug costs will skyrocket. HICAP volunteers are now seeking a more cost-effective plan specific to her needs.
“Seniors around here really need to know about HICAP,” Austin said. “They are the ones who really can help an individual.”
To learn more about the Health Insurance Counseling and Advocacy Program visit cahealthadvocates.org/hicap/.
