Program trains volunteers to counsel people on Medicare

Given the confusion about Medicare A, B, C and D, Advantage Plans, Medigap and what Medicare covers, the State Health Insurance Benefit Advisors (SHIBA) has 43 volunteers available to counsel people on their health insurance and Medicare options with the aim of helping people understand complex choices and save money.

Kathy Dugan

Kathy Dugan, manager of the local SHIBA Health Line, which is funded by the Washington State Insurance Commissioner’s Office and Aging and Long Term Care of Eastern Washington, seeks to spread the word about the program through congregations and nonprofits.

Kathy pointed out three areas where people are under-informed:

• When people are laid off from their jobs, few understand that they have the right to choose to continue their group health plan through COBRA.  The Consolidated Omnibus Budget Reconciliation Act that gives workers the right to choose to continue benefits.

• Those who lose their jobs and have no access to health insurance can find options through SHIBA.

• SHIBA specializes in giving advice about Medicare—explaining the Medicare Advantage plan choices, Medicare Part D for drugs, the Low-Income Subsidy and Medicare Savings programs.

When it first started, Medicare was simple, Kathy explained.  People just took their Medicare card to their doctors and were covered.

The 2005 Medicare Modernization Act set up Medicare Part D for prescription drug coverage, and began subsidies for Medicare Advantage plans.

“Instead of there being one program, there were 66 plans,” she said. “Now there are 30 plans offered in Washington.”

Kathy and volunteers help people who are struggling to understand their choices.

“We offer free, nonbiased advice,” said Kathy, who has worked with the aging population for 20 years—14 of those years as a case manager in Kitsap County. 

For the last six years, she has focused on offering counseling on Medicare through the SHIBA program.

Suzi Hokonson, a volunteer for about a year, said eight volunteers have been there more than five years and one, for 16 years.  Volunteers are carefully screened.  She helps Kathy set up workshops at churches and community locations.

New volunteers attend four days of basic training with the Washington State Insurance Commissioner’s office before working with clients. 

They go through a mentoring process with other volunteers and then attend monthly update meetings to stay on top of all the changes.

The volunteers work a few hours to 100 hours a month, spending an average of four to six hours per client.

“Explaining the complicated issues requires time,” said Kathy.

In addition to one-on-one advising, she does presentations for community groups.  She started meeting with senior center groups several years ago, particularly helping during the Medicare Open Enrollment period from Oct. 15 to Dec. 7. 

Now she wants to meet with people who do not go to the senior centers.  She would like congregations to know about training sessions and to announce them in their bulletins. 

In Spokane County, there are 33 Medicare Advantage Plans.  Plans vary county by county, and doctors choose which plans to contract with. 

If a doctor is not in the contract plan, a patient has to change doctors or pay full price for the care.  If someone moves or vacations out of town, the Medicare Advantage plans may not cover expenses because they provide coverage only in specific service areas.

“One woman saw seven doctors.  With the plan she chose, two were unable to see her.  In addition, with the different medicines she took, there was no single Medicare Advantage plan, which would meet her needs,” Kathy explained.

“Medicare supplemental plans are easier to work with,” Kathy said.  “It’s original Medicare plus a supplement.  Patients with that can go to any doctor but must have a stand-alone Part D for prescriptions.  The cheapest supplemental plan, however, is $172 a month per person, so it can be hard to afford.” 

During open enrollment, Kathy said SHIBA has 25 to 50 calls a day, so it seeks to train more volunteers.  The rest of the year there are three to 22 calls a day.

“If people are aware of their situations and options, they may be able to pay less,” she said. 

“For example, a woman paying $40 a month for a prescription plan was able to have the three drugs she used covered on a plan that cost just $15 a month, saving her nearly $400 in a year.

“That’s a lot to someone who has a low income,” said Kathy, who recommends that people compare the plans every year, because they change every year.

For information, call 458-2509 x 201 or email duganka@dshs.wa.gov.

 

Copyright © June 2012 - The Fig Tree