Navigating the Medicare Maze
By Richard DuPertuis
Ensuring You're Insured
Story and photos by Richard Dupertuis
NOT LONG AFTER Judi Lynch began speaking, her words grabbed me by the throat. It started out safely enough. Lynch was an educator from Health Insurance Counseling and Advocacy Program (HICAP), come to my low-income senior home’s community room to educate us on the ins and outs of Medicare. It began as a fairly interesting talk, then she spoke about the penalties:
“If you don’t sign up for Medicare Part D when you could have, you will face a penalty of 1 percent of your Part D premium per month for every year that you did not enroll.”
My mind reeled. Did I enroll? I didn’t remember enrolling in anything. I raised my hand. That’s a 12 percent per year penalty for how many years? She answered that the Medicare Modernization Act of 2003 went into effect on January 1, 2006, which, I calculated, would be... 13 YEARS?
Then she delivered the grabber: “That penalty would be added on top of your monthly premium for the rest of your life.”
As it turned out, my cold sweat lasted only as long as the rest of Lynch’s presentation. Afterward, I rushed to check in with her, and she jogged my memory. I was on disability in 2006, and Medicare enrolled me in a Part D prescription drug plan automatically. I even remembered I had changed Part D plans some years back, which must have been during the annual enrollment period from Oct. 15 to Dec. 7, the only time of the year you can change such plans.
Though there are other enrollment periods. Lots of them, I came to learn. And lots of requirements, and other penalties, lacing the law that governs Medicare Parts A, B, C and D. Oh, and you can purchase supplemental insurance to cover the 20 percent that Part B does NOT pay toward approved medical expenses. Or you might pay less if your income is low enough to make you a Qualified Medicare Beneficiary, eligible for payment assistance.
It’s even more complicated than that. You might want a guide.
“We help navigate the maze of Medicare,” says Lynch. “It can be overwhelming. I have people coming in here on the verge of tears. Sometimes they’re a little confused, and we always invite them to come back as many times as needed to understand, because it’s a lot to take in at once.”
Lynch serves as assistant program manager in the Redding HICAP office. Her supervisor, Program Manager Pamela Smith-Jimison, heads the office and oversees HICAP operations in Shasta, Trinity, Siskiyou, Modoc and Lassen counties, a service area designated and managed by the California Department of Aging in Sacramento. The first person you meet at the office, however, is receptionist Marie Grano, who tells you she is a real clown.
“I’m Butterfly the Clown and this is my husband, Wheels the Clown, because of his wheelchair,” says Grano, offering a photograph of her spouse and herself in full clown regalia. She doesn’t wear that uniform at work, but she does exercise that sunny personality. “I can calm people who are panicking on the phone,” she says. “If I can make them snicker, I go, yes! I scored another one.”
Grano identifies her chief role as screener, referring calls and walk-ins seeking help with Social Security or Medi-Cal to another office. Only those with Medicare issues or questions get appointments. Frequently she is asked how much HICAP services cost. As provided for in California statue, all services here are free.
On top of her duties supervising five counties, Smith-Jimison regularly counsels beneficiaries herself. Today, she advises a married couple who both just lost medical coverage when he retired from his job, triggering a Special Enrollment Period. Since both of them already had Medicare Part A, inpatient hospitalization coverage, and Part B, outpatient Medical expenses covered by Medicare, and since this five-service area doesn’t offer Part C (other California service areas might), this session focuses mainly on Part D, becoming a search for a prescription drug plan.
After guiding the beneficiaries through all the above, and after explaining Medicare deductibles and shares of cost, Smith-Jimison logs on to the www.medicare.gov web site and begins entering prescriptions drugs for each beneficiary. “There are currently 30 Medicare-approved Part D plans in California,” she tells them. “The medications determine what plan is best for you.”
Once all meds are entered, the website returns a list of plans that cover most – if not all – of the medications they take. Smith-Jimison asks them to make a couple of choices. She can print out a list of plans for them to take home and evaluate, or they can make their choice now and she can enroll them. At no time does she recommend one plan over another. As with advising on supplemental plans, which are provided by private insurance companies, no HICAP counselor can determine which company is best for anyone.
“It’s important we remain 100 percent neutral,” she stresses. “We don’t sell anything. We just explain your choices.”
On top of supervising the service area and counseling beneficiaries, Smith-Jamison, with Lynch, manages appeals for beneficiaries who want to contest a Medicare determination. And on top of that, she trains and supervises volunteers who work out of this office and others throughout the service area. All three
of the women described above started out
Lynch is the educator, who goes out into the community and tells people about HICAP, delighting her audiences with stories about how counselors taught beneficiaries how to obtain required coverage at lower cost, and terrifying them with tales of late Medicare enrollment fees, which inflate monthly premiums for life.
That’s how I learned about HICAP. And while visiting Lynch in her office days later, that’s when I signed up to join the team of volunteers in the Redding office. Then came training where I learned, among a lot of other things, that in some cases you can save a lot of money by spending a little money.
Call or come on down to the office and make an appointment. They’ll tell you all about it. No charge. •
HICAP Planning and Service Area 2 Agency on Aging
1647 Hartnell Ave., Suite 8, Redding
Monday-Friday 9 am-5 pm
Closed Saturday and Sunday