Healthy Living

Figuring out Medicare? Free, local help available

The goal is to save you money, help you find the plan right for you

Local volunteers through the Senior Health Insurance Information Program, or SHIIP, are available to offer free, unbiase
Local volunteers through the Senior Health Insurance Information Program, or SHIIP, are available to offer free, unbiased advice on Medicare coverage. This year’s open enrollment period is Oct. 15 to Dec. 7. (Adobe Stock)

Talk to anyone who has recently retired and signed up for Medicare and you more than likely will get an earful about how hard it can be figure out options for Medicare supplemental and prescription drug plans.

Nearly 53 million U.S. senior citizens are enrolled in Medicare. Signing up isn’t difficult.

But people sometimes need help with the additional coverage because Medicare does not pay 100 percent of most people’s medical bills.

We spoke to two local experts with the Senior Health Insurance Information Program, or SHIIP, a government-run program that provides free, unbiased advice about signing up for or updating your Medicare coverage.

FIRST, LET’S REVIEW THE BASICS

Medicare has four areas of coverage:

• Part A covers hospital visits and skilled nursing care.

• Part B covers a certain percentage of preventive care and doctor appointments, with copay amounts similar to employer-provided health insurance. Medigap is optional supplemental insurance that you can buy to cover expenses, such as copays, that Medicare doesn’t.

• Part C, also called Medicare Advantage, is insurance that can be purchased through private companies that combines and takes the place of Medicare Parts A and B and often provides additional benefits.

• Part D covers prescription drugs.

Louise Harn, a SHIIP volunteer at Mercy Medical Center in Cedar Rapids, said that in most cases, you automatically will be enrolled in Medicare Parts A and B when you turn 65 if you’re already receiving Social Security.

If you continue working past the age of 65 and want to stay on your employer’s health insurance plan, you’ll need to opt-out of Medicare coverage. But consider the cost. “If you have a high-deductible plan, you might want to consider going on Medicare,” Harn said.

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If you haven’t started to collect Social Security when you turn 65, you can sign up for Medicare online or in person at a Social Security office.

Enrolling in Part C — a Medicare Advantage plan — is optional but consumers should consider what type of plan they might want and who to buy it from.

If you buy a Medicare Advantage plan from a salesperson, it’s important to know that person may be receiving a commission and may or may not steer you toward the plan that’s best for you, Harn said.

To ensure you’re working with a reputable provider, she recommends avoiding 800-numbers advertised on TV. “Stay local — find someone with an office in your area,” she said.

People also should strongly consider enrolling in Part D — prescription drug coverage — when they turn 65, Harn said. Otherwise, you might end up paying a penalty if you enroll in Part D later on.

Harn said many people don’t realize this, and she’s seen clients get hit with hefty monthly fees if they skipped that enrollment. Even if you don’t take any prescription drugs now, you may want that coverage if your health changes and you do need to take a prescription drug.

GET FREE, UNBIASED ADVICE

A free phone or online appointment with a SHIIP counselor, available through most area hospitals, can eliminate the need to visit with a salesperson altogether. SHIIP volunteers are unpaid and don’t receive a commission. Instead, they specialize in helping people save money.

“Our goal is to show you all of your options and the associated costs,” Harn said.

A common misconception is that you can only speak to a SHIIP volunteer if you have a low, fixed income, according to Angela Berns, program manager for volunteer services at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids.

The SHIIP program, she said, “has nothing to do with how much money you make.” she said.

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SHIIP volunteers are available to help all new Medicare enrollees, as well as current recipients who may want to update their coverage during the annual open enrollment period — Oct. 15 to Dec. 7 this year.

One of the most common misconceptions, Harn and Berns said, is that you can’t make changes in your Medicare plan once you’re enrolled.

During each fall’s open enrollment period, you can switch Medicare Advantage plans. You also can change your prescription drug plan.

“There are 28 plans available for next year,” Harn said.

Even if your medications are the same, there might be a new or better option available that could save you money.

Understanding your Medicare coverage can have a direct correlation to your overall health, Berns said.

If people are confused by their medical bills, for example, they might avoid seeing a doctor when they should. If they have a more expensive prescription drug plan than they need, they might not get an expensive, but beneficial, medicine.

“People might skip their heart medicine in order to buy groceries,” Berns said.

And that’s exactly what all SHIIP volunteers hope to help you avoid — spending too much or not receiving enough medical care.

“It’s not uncommon for us to save someone $10,000,” Harn said.

MORE INFO

Medicare: medicare.gov

SHIIP: shiip.iowa.gov

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UnityPoint Health: unitypoint.org/cedarrapids/senior-health-.aspx, (319) 369-7475

Mercy Medical Center: mercycare.org/patients/billing-insurance/medicare-faqs/shiip, (319) 861-7887

Mercy Iowa City: mercyiowacity.org/medicare-counseling, (319) 339-3658

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We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

Or if you have a story idea we should look into? Tell us here.