Nearing age 65 and not sure when to enroll in Medicare? Received a bill from Medicare and aren’t sure which course to take? You are not alone. Navigating the multifarious options of Medicare health insurance, often called the “Medicare maze,” is challenging.
SHIP/HICAP, the Health Insurance Counseling and Advocacy Program, is a federal- and state-sponsored, volunteer-supported program that provides free and unbiased assistance to people who need their Medicare questions answered. The California Department of Aging (CDA) provides oversight of the program through contracts with the local Kings/Tulare Area Agency on Aging (K/T AAA).
For over 40 years, staff at the Kings/Tulare HICAP have provided information, and often relief, to Medicare consumers. Destiney Hernanadez, Social Worker II with HICAP, recently counseled Abel Garcia, Medicare recipient and HICAP client, on insurance coverage variables such as benefit coverage, billing, consumer rights, and coordination of Parts B and D. “I have veteran’s benefits, as I am a Purple Heart recipient, so I have no issues with prescriptions, but my wife’s prescription needs were high costing.” Not knowing what to do, Able took the advice of a family friend and went to HICAP.
Destiney explains, “Abel lost his wife, so when he came for services, he was dealing with not only his loss but living with a disabled adult child, his grandchild, and the continuous incoming bills for Part B services his wife had received before her passing.” Destiney and Able worked together to “review bills to ensure that proper payments were made by Medicare, that providers were charging appropriately, and that previous Medicare supplements had processed payments, while also applying for several financial assistance programs through the providers.” Overall, “HICAP helped Abel save $6,583.62,” describes Destiney.
Medicare eligibility and enrollment are basic for most people. You must be 65 years of age or older. (If you are younger than 65, you may qualify for Medicare if you have End-Stage Renal Disease or have been awarded Social Security Disability Insurance.) Enrollment also requires U.S. citizenship or permanent residence and having forty working credits on file with the Social Security Administration (SSA). Once acquired, SSA auto-enrolls people into Medicare who already receive Social Security payments. Most people will receive their Medicare card three months before their 65th birthday. If you’re not already getting Social Security payments, you have a seven-month window in which to enroll through the Social Security office or apply online.
There are two main approaches from which you must decide when enrolling in Medicare coverage: Original Medicare (Parts A/B/D) or a Medicare Advantage plan (Parts C/D). Retiree or employer coverage also factors into how Medicare coverage works. Through Medicare Savings Programs, Medicare also provides “Extra Help,” including Medi-CAL, to lower costs of Part A, Part B, and Part D. HICAP can assist with applications.
HICAP goes a long way toward simplifying the Medicare expedition. As Able described, the help Destiney provided was “Excellent! All the staff are friendly. The program helped me gain confidence when it came to understanding my bills and the process to pay. I felt less stressed as I saw the medical bills decrease or go away. I was able to afford my regular bills, such as house and utilities, without worrying about going into collections for overdue bills.” Although HICAP doesn’t pay medical bills, counselors assist with reviewing Medicare statements and organizing bills received from providers. When necessary, HICAP counselors advocate for Medicare beneficiaries by requesting providers rebill Medicare.
Learn from experience. When asked, “What advice would you give to someone who needs help with their Medicare?” Able reminds us that company helps when approaching milestones such as Medicare. “Don’t put it off. Seek out advice as soon as you can. Expand your knowledge about Medicare and the associated expenses, as the bills can be difficult to understand. Some businesses that bill can be persistent, and they use scare tactics to make you feel like you have to pay right away. Use HICAP services to get help to understand how to read your bills. There is lots of help available.”
Already have Medicare and are looking for ways to help others understand it?
BECOME A VOLUNTEER! We need volunteers in four areas:
Community Educators: speak to groups, companies, civic, tribal, faith-based, employer, and retiree organizations.
Counselors: provide one-on-one assistance to beneficiaries and their families or representatives.
Senior Medicare Patrol (SMP) Liaison: educate and inform on how to protect, detect, and report suspected Medicare fraud.
Special Projects: answer phones, assist with outreach events.
Can you help? If you are interested in learning more or want to volunteer, call your local SHIP/HICAP office at (559) 713-2875 or 1-800-434-0222 for an appointment. Already decided to volunteer and need more information? Visit the K/T AAA website at ktaaa.org or call Blanca Alvarez, Volunteer Coordinator, at (559) 713-2874.
Article written by Dori Silveria, HHSA Aging Services
This project was supported in part by MIPPA grant 2201CAMISH-02 and grant number 90SAPG0052-02-01 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. HICAP operates with additional financial assistance and support from the Kings/Tulare Area Agency on Aging and the California Department of Aging (CDA).