| Mon, Sep 17, 2018 @ 10:31 AM

Help for Getting the Medicare Coverage You Need

Posted by Medicare Made Clear

As part of National Medicare Education Week, we asked leaders from organizations and companies in the health and aging fields about preparing for Medicare Annual Enrollment, which runs from Oct. 15 to Dec. 7. This is the time each year when you can change your coverage choices for the following year. Today we focus on getting the services you need while managing your costs.

We spoke with Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging (n4a). Markwood has more than three decades of experience in aging, health, housing, human services and transportation in cities and counties. She has been with n4a since 2002.

Q: Where can people go to find help navigating Medicare, including programs and services to help them manage health care costs? 

Markwood:  Each state has its own SHIP (State Health Insurance Assistance Program), whose services are operated at the community level, often by a local Area Agency on Aging. They provide free, confidential, personalized counseling for Medicare recipients and their families. That counselor is going to be an objective source of information who will advocate on your behalf and help empower you to make informed health care decisions.

Counselors will never promote a specific insurance product. They will help you compare and enroll in Medicare plans, such as a prescription drug plan (Part D), a Medicare Advantage plan (Part C) or a Medicare supplement plan (Medigap).

Q: What type of questions can a SHIP counselor answer?

Markwood: They can answer common questions we often hear, like what does Medicare cover, what doesn’t it cover, and does Medicare cover nursing homes (the answer to the latter is mostly no). They can describe the differences between what is covered by Medicare and Medicaid, what your prescription drug plan covers, whether you may need a Medigap plan and what you can do if a claim is denied.

There are resources on the web, including Medicare.gov. But you may find that talking it through with a counselor is really critical to navigating the process and getting the answers you need.

Q: What is the PACE program and how can it help people on a fixed income?

Markwood:  PACE (Programs of All-Inclusive Care for the Elderly) is an incredible program that helps people on fixed incomes, typically those who are eligible for both Medicare and Medicaid. It blends medical and social services like nutrition, transportation to medical appointments and social engagement. Its goal is to help people remain engaged in the community and not have to seek nursing home care. Some Area Agencies on Aging provide PACE programs, but they are not available everywhere. To see if there is a PACE program in your area, check here.

Q: What help can Medicare recipients get in paying for their prescription drugs?

Markwood: There is financial assistance available for Medicare recipients who meet certain income and resource limits. If you are on Medicaid or receive SSI, you automatically qualify. If you don’t qualify, your state may have other programs.

You can get your prescriptions covered in two ways. You can add a standalone Medicare Part D plan to Original Medicare (Parts A & B) or you can enroll in a Medicare Advantage plan (Part C) that includes drug coverage. Plans can change coverage and costs every year. It’s critical that you review your plan every year to make sure that the drugs you currently take are covered. SHIP counselors can help you with this, also.

Q: Is there financial assistance for people who need dental, vision or hearing care?

Markwood: Those are key areas for older adults, but there are limited benefits under Original Medicare. However, there are Medigap and Medicare Advantage plans that often cover these services. I encourage people to research their options.

For more information, explore www.NMEW.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.