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Mysteries of Medicare: Who Can Help Demystify Medicare?
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he State Health Insurance Assistance Program (SHIP) is a national program set up to assist those eligible for Medicare as they navigate Medicare enrollment, coverage, issues, and other options. In Pennsylvania this program is called Pennsylvania Medicare Education and Decision Insight (PA MEDI). Until July 2021, the PA program was called APPRISE. The Chester County PA MEDI program is staffed with a coordinator and volunteer counselors. Our local program coordinator and volunteer counselors operate within the Chester County Department of Aging. The counselors provide free, unbiased, confidential guidance with oneon-one counseling. Counselors are the key to the program. To become a PA MEDI counselor, the volunteer must pass a background check and go through a certification process that includes online training modules, two days of classroom instruction or four days of virtual training, a competency exam, and a period of working with a mentor before counseling clients on their own. Once certified, training continues with monthly meetings, webinars, and semi-annual regional updates. The counselors come from varied backgrounds and areas of expertise. (Comment from client who received one-on-one counseling): “Michael was phenomenal in helping me get my Medicare coverage in a very timely manner after I was having communication issues with Social Security Administration.”
14 CHESTER COUNT Y Medicine | SPRING 2022
When can Medicare enrollment take place? Individuals have three different opportunities to enroll in Medicare. It is important to know the enrollment timelines for Medicare. People who have been collecting Social Security benefits before turning 65 will automatically be enrolled in Part A and Part B of Medicare upon turning 65. After the 24th month of Social Security disability, Medicare enrollment is also automatic. Otherwise, enrollment is required and should occur within the 7-month period surrounding the 65th birthday (3 months before, the month of the 65th birthday, and 3 months after). This is the Initial Enrollment Period (IEP). There are two other opportunities for Medicare enrollment. These are SEPs and the GEP. A Special Enrollment Period (SEP) is available if leaving employer coverage after working beyond Medicare eligibility. If a beneficiary misses the IEP and an SEP, there is a General Enrollment Period (GEP) each year from January 1 – March 31. With this option, coverage will begin July 1 and there may be a late enrollment penalty. Each enrollment period has different rules, which can be confusing. PA MEDI counselors are acquainted with these enrollment periods and the rules for each. Counselors can help beneficiaries understand what applies to their individual situations.
With Medicare, what else is needed? There are still some important decisions to make even when Medicare enrollment has been completed. At the time of Medicare eligibility beneficiaries may want to consider other
