Help available in choosing Medicare supplement plans

Nov. 23-- Barbara Torrisi received an unpleasant surprise when she reviewed her Medicare Advantage insurance policy and learned the copay for one of her prescriptions would increase, costing her an additional $680 next year.

The 74-year-old Moosic woman decided to shop around for a better deal. With more than a dozen plans to choose from in Lackawanna County, she wasn't sure she'd make the right choice.
She turned to Apprise, a free, state-funded health care counseling program that helps Medicare recipients navigate the complex world of supplemental and additional insurance plans. Open enrollment for plans ends Dec. 7.

Volunteer counselors helped Mrs. Torrisi find a new plan that reduced her prescription costs. As an added bonus, the new plan has no monthly premium, which will save her an additional $59.50 per month for a total of nearly $1,400.

"There is so much confusion about insurance," Mrs. Torrisi said. "They did it more quickly and efficiently than I could have by myself."

Apprise is offered in every county by the Area Agency on Aging. In Lackawanna County, the agency provides the service through the Voluntary Action Center, a nonprofit social service agency at 829 Jefferson Ave., Scranton.

Apprise coordinator Terri Mandigo heads a team of 21 volunteers who provide one-on-one counseling to area residents seeking insurance coverage for services that are not covered entirely by Medicare Part A, which pays hospitalization costs, Part B, which covers doctors visits and various tests, such as lab work and x-rays, and Part D, which covers prescriptions.

Know the options
There are two options for people who want additional insurance to original Medicare: One option is supplemental insurance, known as a Medigap policy. The other is additional insurance, known as a Medicare Advantage plan.

The main difference between the plans is a Medigap plan covers most to all out-of-pocket expenses, including co-pays, co-insurance and deductibles associated with Medicare Part A and B, depending on the plan. It does not pay for prescription drugs, however. Subscribers pay a monthly premium to a private insurance company, in addition to the cost of the Medicare Part B premium paid to the federal government, which in 2015 was $104.90 per month.

A Medicare Advantage plan has a less expensive monthly premium, but it has a deductible, co-pays and co-insurance, leaving the recipient to pay out-of-pocket expenses. The annual out-of-pocket maximum can range from around $3,500 to $10,000 per person. Most Medicare Advantage plans include prescription coverage.
Daunting decision
Deciding whether to enroll in a Medigap or Medicare Advantage plan and then choosing the right plan can be a daunting task, Ms. Mandigo said.

"People are not educated and don't know the questions to ask. If you don't know what questions to ask, you're not going to get the right information," Ms. Mandigo said.

Apprise counselors are specially trained to know all the ins and outs of all types of policies to help participants make the right choice. They are independent of insurance companies, so residents can rest assured they're getting unbiased advice, she said.
"We can't recommend a plan but we can lay everything out in black and white," Ms. Mandigo said.
That's helped thousands of people save money. A study conducted last year showed between April 2013 and March 2014, Apprise helped 2,087 Lackawanna County residents save $102,660, she said.
Complex list

Mrs. Torrisi and Mary Marino, 89, of South Scranton, sat down with an Apprise counselor on a recent afternoon to search for Medicare Advantage plans. A full list is available on the federal Medicare Website at Medicare.gov.

The site allows Medicare recipients to enter specific information about themselves. It then brings up a list of available plans that includes detailed information on the monthly premium, coverages and various costs so they can do a side-by-side comparison.

The site requires users to put in a lot of information, including all their medications, and navigate through multiple screens. That can be confusing for elderly residents, many whom are not computer literate, Ms. Mandigo said.

"There's too wide a range to make a decision," Ms. Mandigo said. "They need some help narrowing it down. If you can get it down to two or three, it's manageable."

Mrs. Marino said the Apprise counselors provided her invaluable assistance.
"They went through all the medications I have and tried to find the best plan for me," she said.
Apprise counselors also assist clients in researching Medigap policies and help those with low income apply for other programs that provide additional financial help in paying costs not covered entirely by Medicare. Those programs included the "extra help" program offered by the Social Security Administration that helps cover co-pays under Medicare's prescription drug program and PACE, the state program that helps cover prescription costs.

Regarding Medigap policies, the Medicare.gov website provides general information regarding the types of policies available and provides links to individual insurance companies. Apprise counselors also have access to a non-public website run by insurance companies that allows for a more detailed comparison of the policies, Ms. Mandigo said.

'Guaranteed issue right'
Ms. Mandigo said it's important for people to carefully consider whether they want a Medigap or Medicare Advantage program when they first become eligible for Medicare.
That's because federal law requires all insurers who offer Medigap plans to accept new clients without asking any health history questions within the first six months of the date they are first eligible for Medicare. For most people that is when they turn age 65, though disabled people younger than that can also qualify.

After that six-month period, known as the "guaranteed issue right," an insurer can reject an applicant for a Medigap policy for medical reasons and/or charge them a higher premium. That same rule holds true if a person wishes to change Medigap companies once they have a policy.
There are fewer restrictions with a Medicare Advantage plan, which can only reject a person if they suffer from end-stage kidney disease, she said.

Contact the writer: tbesecker@timesshamrock.com
Open
enrollment
Open enrollment for Medigap and Medicare Advantage plans began on Oct. 15 and will end Dec. 7. Lackawanna County residents can seek assistance in choosing a plan by contacting Apprise at the Voluntary Action Center at 570-347-5616. In Luzerne and Wyoming counties, contact Apprise at the Luzerne and Wyoming Counties Area Agency on Aging at 570-822-1158 or 1-800-783-7067.
Additional information on Medicare and insurance plans is available at Medicare.gov.

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