SHIIP helps seniors navigate Medicare choices

Choosing the right Medicare coverage plan is not an easy process, especially if you’re applying for the first time.

The Seniors’ Health Insurance Information Program (SHIIP) was created by the North Carolina Department of Insurance to provide information to beneficiaries and caregivers about Medicare, Medicare supplements, Medicare Advantage, Medicare prescription plans, Medicare fraud and abuse and long-term care insurance.

The Dare County Department of Adult & Senior Services has two SHIIP service coordinators, Brandi Head Rheubottom and Emily Karr. Eight volunteers are trained to counsel people about different Medicare plans and fraud detection through Senior Medicare Patrol.

It’s important to choose the right plan carefully because if you have Medicare Part D or Medicare Advantage, you’ll not be able to make a change until the annual open enrollment period.

This year’s open enrollment is Oct. 15 to Dec. 7. During this time SHIIP counselors will help review and explain each plan for 2013. Medicare beneficiaries can add, drop or change drug coverage, switch from an original plan to Medicare Advantage, or vice versa. They can also go from one Advantage plan to another, such as one that has drug coverage versus one that doesn’t.

The new choices take effect Jan. 1, 2013. If your current coverage will meet your needs for next year, you don’t need to do anything.

Plans that look good on paper will not work for everybody.

“What people don’t know is that there are doctors here on the Outer Banks who don’t accept Medicare or some Medicare Advantage plans,” Rheubottom said.

In those cases, she said, patients end up paying more for services than what they save on their premiums.

Medicare Part D prescription drug coverage first became available in January 2006. Applying for the plan is available only online at www.Medicare.gov  or by calling 1-800-633-4227.

“That’s when people started calling SHIIP because they need to know how to do it,” Rheubottom said. “The waiting time on these calls is often long, and older folks really like to talk to a live person, especially for this kind of stuff.”

The Thomas A. Baum Senior Center has an office dedicated to SHIIP counseling furnished with a computer and phones. SHIIP counselors can help you find the right Medicare Plan D through the computerized process.

“Basically people bring a list of their prescription drugs they use and the counselor helps them using online resources. The system will show three plans to choose from based on their information,” Rheubottom said.

Be aware that if you do not enroll in Medicare Part D when you first become eligible and you choose to enroll later than 65 days, then you may have to pay a 1 percent monthly premium penalty for all the months accumulated.

“If you already have prescription drug coverage at least as good as or better than Medicare’s coverage, then you’re good to go,” Rheubottom said.

Plans are subject to change every year. Some changes are due to health care reforms. For example, The Affordable Care Act has made significant changes to Medicare Part D plans. More than 114,012 people with Medicare in North Carolina received a $250 rebate to help cover the cost of their prescription drugs when they hit the “donut hole” (a term for Medicare prescription drug coverage gap) in 2010.

In the first five months of 2012, over 20,000 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole and 14 percent on generic drugs. This discount has resulted in an average savings of $636 per person.

SHIIP Counselors can explain plans in detail, help you compare them so you can choose a plan that will save you money on monthly premiums and get the coverage you need.

Call Dare County Adult & Senior Services to set up an appointment: Thomas A. Baum Senior Center, Emily Karr at (252) 475-5638, Fessenden Center at (252) 475-5647, Dare County Center, Sandy Scarborough at (252) 475-5625 or the state Department of Insurance at (800) 443-9354.

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