Medicare health insurance counseling is available

Link to article in Sun Current

Dawn Lund calls herself “a Medicare nerd.”

“I’ve always worked in the aging field,” said Lund, who is director of Medicare programs at Senior Community Services in Minnetonka.

Fall has been a busy time for the agency for the last 20 years, when they began offering Medicare health insurance counseling.

“Our agency and Linkage Line are the only two in Minnesota who offer unbiased counseling,” Lund said. “We assist people with non-biased guidance on Medicare options year-round.”

In 2015, an estimated 1,717 clients received help through Medicare health insurance counseling classes offered at Senior Community Services. It is just one of the programs offered at the agency, whose vision is to “mobilize the community to reimagine aging.” The agency offers educational workshops at several locations, plus confidential, individual assistance by appointment at nine locations for people who need more help.

A total of 45 active volunteers conduct the classes, after receiving 20 hours of training.

“The caliber of people [volunteers] we get is kind of incredible,” Lund said.

The open-enrollment period for insurance this year runs from Oct. 15 to Dec. 7. You can select coverage for the first time then, or make changes in your current coverage.

“Everybody’s situation is different, Lund said. “It’s like a puzzle.”

During the enrollment period, you can make changes to various aspects of your coverage.

  • You can switch from Original Medicare to Medicare Advantage, or vice versa.
  • You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another. And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.

Among the most important decisions newly retired people must make is what to do about health care once they are no longer covered by their employer’s plan.

Even if they’ve been retired for some time and chose a health plan in the past, each year’s open-enrollment period gives retired persons a chance to reconsider other, sometimes better, options. It is wise, during the open enrollment period, to check a plan to see if there will be changes; check prescription lists and coverage for those prescriptions; and then check on new plans and changes to other plans to be sure coverage is being provided at the most affordable cost.

According to Lund, it is important to have a secondary plan in place to assist with the costs that Medicare does not cover. For example, when you go to a doctor, Medicare covers 80 percent of that cost. With nothing else in place, you are responsible for the remaining 20 percent.

For people who cannot afford another plan, Lund said, Senior Partners Care is “one of the best kept secrets in Minnesota.”

“It is not insurance,” she said. “It is a community-based program that enables Minnesota Medicare recipients to access the medical care they need.” The program bridges the financial gap between an individual’s medical bills and his or her Medicare coverage.

SPC has partnered with most of the major metropolitan area hospitals and hundreds of clinics and providers statewide. These healthcare providers (SPC Partners) have agreed to accept Medicare as full payment for Medicare covered expenses. They waive the Medicare deductibles, coinsurance, and copayments.

To be eligible, you must have Medicare parts A and B, receive care from participating medical providers, meet income and asset thresholds, and submit an application along with a $42 annual application fee. Participants cannot exceed $1,980 monthly income and assets cannot exceed $48,600 (not including a home and one car).

Partners in the program who have agreed to accept Medicare as full payment include Fairview, Health East, Hennepin County Medical Center (HCMC), North Memorial and Park Nicollet.

Along with Medicare and a supplementary coverage, people age 65 and over need to have a prescription drug plan, Lund said. “So many people who turn 65 and don’t take any medications assume they don’t need a plan,” she said. “If you don’t sign up and need it, you pay a penalty. You’re punished for being healthy.”

She suggests that people with drug plans review their plans every year, making a list of their medications and then researching to find the most economical drug plan that fits their needs. Couples who sign up for the same plan may find that they should have different drug plans, depending on the medications they need.

“So many people have high-cost medications,” Lund said. “A lot of people with diabetes find that even with a drug plan the medications can still be costly. Prescriptions can go up $20 to $30 from one year to the next.”

CareNextion helps with senior caregiving

Another of Senior Community Services that may be helpful to older adults and their families is CareNextion.org, a free website.

“This secure and confidential internet resource mobilizes family, friends, and neighbors to help communicate and coordinate care for an older adult,” said Deb Taylor, CEO of Senior Community Services.

She noted that only 16 percent of older adults live with loved ones who can provide supportive care. “We see many older adults living independently at home well into their 80s, 90s and beyond, who need help with cooking, shopping, household chores and health needs,” Taylor said. “Consequently, we constantly hear from families, especially those with members dispersed across the country, who need help coordinating and managing care for an older loved one. And many of these devoted caregivers grow weary and overwhelmed by providing constant care.”

CareNextion is designed to strengthen informal support networks through centralized coordination of care, task assignment, journaling and communication with care team members.

“A typical care scenario involves adult children living far from a parent and trying to coordinate care for Mom or Dad from another city,” Taylor said. “With CareNextion, they can create and manage a care team of relatives, trusted neighbors, and friends who can help share caregiving responsibilities.”

Everyone who has the confidential password can log into CareNextion to find local resources, see upcoming appointments, and coordinate transportation and other needed tasks and household chores. Caregiving is better organized, thus reducing the need for constant phone calling and emailing multiple people.