The Age Guide: Perspectives on the Aging Journey

Navigating Medicare Re-Enrollment with a SHIP Counselor

• Age Guide • Season 2 • Episode 8

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In anticipation of Medicare Open Enrollment that begins October 15th, Val Guzman, AgeGuide's Benefits Access Specialist, interviewed Jennifer, a Senior Health Insurance Program client. Jennifer called AgeGuide looking for help to find a Medicare plan that fit her unique medical needs. Val and Jennifer talk about the ins and outs of Medicare and Medicaid while giving tips on how you can navigate Open Enrollment this fall. 

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SPEAKER_01:

Hello, and welcome to the Age Guide, Perspectives on the Aging Journey. We are here to be your personal age guide and enhance your quality of life on the road ahead. In anticipation of Medicare open enrollment that begins on October 15th, Val Guzman, Age Guide's Benefit Access Specialist, interviewed Jennifer, a Senior Health Insurance Program client. Jennifer called Age Guide looking for help to find a Medicare plan that fit her unique medical needs. Val and Jennifer talk about the ins and outs of Medicare and Medicaid while giving tips of how you can navigate open enrollment this fall. Let's listen in.

SPEAKER_02:

Thank you, Jennifer, for taking the time to talk again and to talk a little bit more about the Your experience with talking with me and talking with a ship counselor, I think getting an idea of what your experience was like will help a lot of other people. So just to kind of think back to where we were when you first called in, Do you remember how you felt when you first started thinking about Medicare and all the decisions that you now had to make?

SPEAKER_00:

Overwhelmed. There's just too much information and there's no real direction of where to go or what to pick, what to look at, what even... like you should look at choice-wise or kind of how the whole system works. So it's almost like there's too much information and there's no real consistency of how it's organized. So you're in this insurance already, so you don't really know how that works. Is it going to affect you later on or in the long run? Or are your doctors going to be covered? What about if you're currently seeing doctors like I was? That was my big thing. And almost all of mine are specialists. And that's always an issue is to try to make sure that the same doctors are covered.

SPEAKER_02:

I'm glad you were finally able to get in touch with us, or at least someone with the SHIP program, because there are several SHIP, the Senior Health Insurance Program. It is a statewide program, so people like myself get trained on Medicare. We're available throughout the state, but right, it's that people don't know that we exist. It can take time. before you actually get in touch with us. And I think trust is a big thing, too, when it comes to doctors. If you trust them, it carries the rest of the relationship with them, where you know they'll talk to you a certain way or you have a certain... rapport or a certain understanding of how you both work together. I think that always goes a long

SPEAKER_00:

way. It's huge. I have a lot of really rare diseases. So yeah, I probably do know more about it than the average bear. So I probably do know more about what I have than maybe their standard doctor does. So Because of that, I need doctors that understand that I know what they're talking about and I need an insurance that's able to be fluid like that so that I can switch if I need to.

SPEAKER_02:

That's the unfortunate part sometimes of healthcare where sometimes even just accessing the services you need is just a huge barrier because of the way doctors work, and then also because of the way insurance works. Unfortunately, right, that does lead sometimes to people not getting the care they need, or avoiding it or delaying it, and then that can lead to even more health issues down the line.

SPEAKER_00:

Definitely, your quality of

SPEAKER_02:

life then goes down. That's, I mean,

SPEAKER_00:

tremendously.

SPEAKER_02:

Right. I think that's another big thing that I mean, I think all around that isn't given as much attention is that if you're not able to see your doctors or get the health care you need, your quality of life is most likely going to go down. You're not going to be able to do the things that you normally do or that you want to do, especially as you get older. And that's why I think having the health coverage you need or you having the resources to be able to choose the coverage you need, it really leads to just so many other benefits or just this better quality of life. And then that way, as you get older, you're able to live just a more independent life, more fulfilling life, or more so what you imagine it to be.

SPEAKER_00:

Yeah, and I didn't even know the insurance that I picked had a case manager, like a free case manager who now I am utilizing because I was having so many issues. I was getting overwhelmed. So now I'm using the case manager and she's handling stuff for me as in finding doctors because like when they refer you, which... You know, a lot of them do. So one specialist will refer you to another specialist. And what I've found is happening now is that even though it's Blue Cross Blue Shield, people see the Medicare in the card title and they're like, oh, no, we don't take that. So now I called Blue Cross Blue Shield directly, told them what the issue was. that was going on. And since I have a chronic illness, I got a case manager to help me navigate that.

SPEAKER_02:

Right, it's something that I think also SHIP counselors are able to help with is even if you are happy with your coverage, you don't need to need help comparing other plans. I mean, since SHIP counselors are familiar with how these plans are set up and the benefits that are available, with these plans, at least we can just answer those questions about what benefits are available, whether it is regular Medicare or through an Advantage plan. There's often just a long list of other benefits or services that people don't know about that can also help, just like the case management services that you're able to use now. Going back to what you said before when you were searching for the plans and you mentioned that you went to the insurance company's website to look at the plans, that is also a common issue that I get from the clients that I help is that I think it's maybe just a first instinct to check directly with an insurance company as far as their Medicare options. So it can seem like it's actually kind of cumbersome to look for or compare plans because now you would have to go to each insurance company's website, right? But then that's where, well, what I normally use and what usually SHIP counselors normally use is the Medicare website. That's just medicare.gov where it does have a very useful, more comprehensive tool that'll show you just every single plan that's available to you. It'll show you your medication costs. So that's always, that's also publicly available. So anyone can always access that.

SPEAKER_01:

Age Guide is conducting a community needs assessment and we need your help. We'll be right back. to find a link to the survey and find more information about our listening sessions.

SPEAKER_02:

So if you remember when we were looking at those plans and looking on that website, do you remember what that was like when we were just going from plan to plan? What was that like?

SPEAKER_00:

That was really easy. It was easy when we were doing it together because I had already filled in, because you told me to, do all the pre-prep work of filling in all of my information. So I did that pre-prep of filling in all of my prescriptions and doctors, because there was a lot of them. So I did all that due diligence beforehand. And then we were just able to go through the plans a lot easier than without me having to fill in any information. So that... That worked out really well because there's a lot of plans to look at and what they have, too, because there's a lot of different factors to kind of consider. Do I want dental coverage and vision? And, I mean, so there's really a lot to consider overall, right? That is

SPEAKER_02:

the tough part. It's a very good tool. I really like it. It's both, I think, good or can be bad that it gives you so much information. It gives you a really good estimate of what the cost will be. But if you don't understand it because it's just so much information to keep track of, that's where sometimes it's easy to get stuck. Even though it's all there, it's easy to, you can get stuck kind of trying to understand which one actually is the one that you should sign up for. And

SPEAKER_00:

it looks like there's too much information. Like you're like, you're like, it's like the old school. I went into the record store and I didn't pick up anything because I don't know what music I like anymore. There was too many choices. so it's like that it's like it was overwhelming I left with nothing because that's what it felt like because I'm just like I don't know what to do here I mean this one looks good but seems like a lot of money out of pocket because I'm not 65 yet so for me then I have to you know pay more out of pocket so that already was an issue too. And then I'm like, whoa, that's more than what I'm paying just, you know, like my regular do the healthcare.gov site, which was already outrageous. So that was, and obviously since I'm on a fixed income, that also was concerning to me that I'm picking a plan that I can actually make basically manage financially, but also works for me so that I'm not stressed out because that's a huge factor in like my healthcare. And actually the doctors keep telling me that too, that I need to find other ways to be less stressed. I guess I'm just a stressy

SPEAKER_02:

person. No, no. Cause then even if, right. I mean, people have so many other things to deal with on a daily basis. And then if you're new to Medicare or now you're faced with all these very complicated choices, trying to do it on your own or, or even learning about it on your own, it's a, It's a lot. I think it's a lot even for SHIP counselors that go through training to learn about the ins and outs of Medicare. It's almost impossible for us to know everything, but we do have the resources to be as familiar as possible with it, but also to to find those answers for you because even if you are willing and able to find the answers, it's just, there's so much information out there. It's hard to know whether what you're reading or seeing is actually accurate and whether it will lead to you having the health coverage that you need.

SPEAKER_00:

And that was the other thing that I kept getting laid down wormholes that were like, Oh, if you are on Medicare, then, or if you're going to apply for Medicare, we can get you this. Well, it doesn't really take you to the Medicare site. It actually is some third party thing that just wants to sell you something. And it's not really affiliated at all with Medicare. And you're like, and they want you to pay for something. I'm like, what's this? No, this isn't, you know, what I want. And that happened a lot when I was looking.

SPEAKER_02:

Right, because that's something that just so many people go through every day where there's so many calls, whether they are scams or whether they are insurance companies, sometimes insurance brokers, offering these plans or these extra benefits. But what a lot of times they don't maybe explain fully is that that there are plans that do offer these benefits that they're talking about, but it usually requires signing up for that specific plan. And that could have some huge or lead to some huge changes to your health coverage. So I always advise people if you are already on Medicare and you're getting letters in the mail or if you're getting these constant phone calls is that a lot of times it is people trying to sell you different coverage or certain Medicare plans and just always be careful. It's always best to to guard your information, your Medicare number, any other information, make sure you're only sharing that with people you know. And even if you are interested in what they're selling or what is actually available to you, that's also, I think, a huge benefit of the the senior health insurance program is that we're not affiliated with any insurance companies. We don't sell any type of insurance. We're really just a resource. We're an unbiased counseling service. We're actually not able to tell you what to sign up for or recommend one plan over the other. So in that type of situation, just know if you get a call and if you if it is something you might be interested in, you can always check with us and we'll let you know if it is actually real. And if you wanted to sign up, we can show you how to do that. So it's always good to be careful with that type of thing. I

SPEAKER_00:

like that too. And now they're getting, I mean, they are getting sneakier because they're becoming via text. So the amount of text messages that you're getting of spam text that look like legit, like they could be coming from Medicare, but they aren't, are definitely increased.

SPEAKER_02:

I'll quickly mention, or I'll quickly mention too, that there is a federal program called the Senior Medicare Patrol that's all about educating Medicare beneficiaries on how to avoid and protect yourself from Medicare fraud and abuse. I'll say we can always talk about that in a different episode, but just know that there are also ways that you can report these types of scams or if you feel someone has stolen your Medicare information or is using your Medicare benefits, that's something that you can also report to Age Guide. And then one other quick thing that since we're almost or headed in this direction was since the, even though you just signed up for your coverage for the rest of this year, the Medicare open enrollment period is actually coming up pretty soon. The annual Medicare open enrollment period is from October 15th to December 7th every year. So Jennifer, you'll actually have to do this again where you, I would say I recommend to everyone to always compare your options with Medicare every year because there could be just a different either prescription plan or if you are enrolled in a Medicare Advantage plan. Since these plans change from year to year, there could be a new plan that actually saves you more money or it covers you better. So it doesn't hurt to compare those plans every year. It's just I always still like to recommend at least checking because even if you check and if you just confirm that it is still the plan that works best for you, then it's usually a pretty quick call. And you don't usually have to do anything different because usually the insurance companies automatically sign you up for the same plan. But even then, the other recommendation I have is that usually towards the end of September or early October, you'll receive a notice from your insurance company that confirms that they'll continue to offer that plan and they're going to automatically enroll you in that plan for the next year. So that's something to keep an eye out for. The insurance companies have to send those out. So you should see that, I imagine. uh later in september um but always feel free to to call either myself or or for anyone else just know you can either call into uh your local ship site to speak with someone or to set an appointment, we can always answer your questions or help you compare those plans.

SPEAKER_01:

Thank you for listening to The Age Guide, Perspectives on the Aging Journey. We hope you learned something new on this podcast because we all have a stake in promoting a high quality of life for people on their aging journey. Age Guide coordinates and administers many services for older adults in Northeastern Illinois. We serve DuPage, Grundy, Kane, Kankakee, Kendall, Lake, McHenry, and Will Counties. Our specially trained professionals are available to answer questions and connect you with local service providers and resources. If you are interested in these services or want to learn more, go to our website at ageguide.org. Call our offices at 630-293-5990. Please follow our podcast so when we post our monthly podcast, you are notified on your streaming account. Thank you, and we will see you next time on The Age Guide, Perspectives on the Aging Journey.