Merlene Davis: Counselors can help with confusion about Medicare, drug plan enrollment

Herald-Leader columnistOctober 9, 2013 

The caller wasn't pleased.

She said she had Medicare coverage but the Affordable Care Act was forcing her to buy medical insurance she didn't want.

It is a concern Angela Zeek, a State Health Insurance Program (SHIP) coordinator, has heard many times.

"If they have Medicare they need to do nothing," Zeek said. "There is a lot of confusion out there."

And it doesn't look like the dust will settle for a while, especially for those receiving Medicare.

In addition to all the information coming at them from TV and by mail, Medicare recipients have to be aware of the open enrollment period for the Part D Drug Plans, and for the Medicare Advantage Plans. The open enrollment period for those plans is Oct. 15- Dec. 7.

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Those plans are Part D and Medicare Advantage.

During the enrollment period, people are urged to compare the plan they currently have with others that are available. Sometimes, Zeek said, the plans change the policies and the drugs they pay for.

"Everyone should compare their policies every year," she said. "People do not want to compare their drug polices because they are afraid they will lose it."

There is an average increase in premiums this year of $5. People are notified when a company drops out of the plan, but too often people don't realize a particular drug has been dropped by a company until they try to get a refill in January.

Fortunately, the counselors at the SHIP, a service offered in this area by Legal Aid of the Bluegrass, are here to help. SHIP is a national program that provides assistance and counseling to seniors and the disabled, their families and caregivers at no charge.

They don't push any particular plan or insurance provider; they fit those providers to your needs.

This year, SHIP also will be helping to enroll children into the Kentucky Children's Health Insurance Program (KCHIP), which is free or low-cost health insurance for children. KCHIP is for children younger than 19 who do not have health insurance and whose family income is less than 200 percent of the federal poverty level. That means a family of four, for example, can earn up to $47,100 a year and qualify for KCHIP.

At the same time, Zeek said, counselors will be able to advise a family if they qualify for the Medicaid Expansion, which extends coverage to 300,000 adults earning up to 138 percent of the federal poverty guideline.

With more than 600,000 uninsured adults in Kentucky, the new expanded Medicaid, courtesy of the new health care law, will cut that number in half, Zeek said. The only criterion is income.

The old Medicaid policy only covered adults with dependent children, leaving many low-income individuals with no medical coverage.

Plus, of the remaining 300,000, 80 percent of those people will be eligible for some other kind of assistance to pay for premiums, deductibles and other out-of-pocket costs, she said. The Extra Help Benefit, for example, can save individuals $4,000 a year. Zeek said thousands of Kentuckians who qualify for that benefit never apply.

"A lot of our people will get insurance that they haven't had previously," she said.

So if there is any confusion, any fears, any doubts about what to do to ensure you have the best medical coverage possible, call the counselors at SHIP.

They are hosting enrollment events in 30 counties to help folks. Call (866) 516-3051 to make an appointment.

Merlene Davis: (859) 231-3218. Email: mdavis1@herald-leader.com. Twitter: @reportmerle. Blog: merlenedavis.bloginky.com.

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