Mysteries of Medicare Who Can Help Demystify Medicare?

The 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.

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.

(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.”

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

options for help with medical expenses, such as a Medigap policy, a Medicare Advantage Plan, and a Part D Prescription Plan. PA MEDI counselors can provide detailed information on all these options. Counselors have access to an actuarial website that provides important Medigap considerations, such as pricing, that are not usually included in the advertising brochures flooding your mail and inbox. During personalized, one-on-one counseling sessions, clients are routinely screened for eligibility for government assistance programs such as Medicaid, Extra Help, Medicare Savings Program, and PACE. Counselors will provide assistance with applications for these programs, if needed.

“I’m researching Medigap and Part D plans for my sister and have some questions as the medicare.gov is a bit confusing.”

When do PA MEDI counselors schedule appointments?

In-person, one-on-one counseling has generally taken place at local senior centers or other community sites. Since the beginning of the pandemic, counseling has been done mostly by phone or Zoom. In-person counseling is now available on a limited basis. Some of the senior centers are beginning to open to the public. Counseling is available year-round, but the busiest time is during the Annual Open Enrollment Period (AOEP) from October 15 to December 7. One-on-one sessions during the AOEP include a review of Prescription Drug Plans and Medicare Advantage Plans using the Medicare website Plan Finder tool. These reviews may help beneficiaries find a new plan that can save hundreds, even thousands, of dollars over the course of the year. (Comments regarding assistance during AOEP) “For the past two years you have been of great assistance with helping me to enroll in Medicare Part D Prescription Plans. Your assistance has saved me at least several thousand dollars this past year.”

“Thanks so much for all your time and patience with us as we navigated the Medicare Part D world with you. Your knowledgeable assistance is the reason we are able to save money and understand the process so that we can make the necessary decisions -- we can’t thank you enough.”

What are some special situations when PA MEDI counselors can assist Medicare beneficiaries?

Counselors help clients with all kinds of issues and questions related to Medicare coverage: understanding a bill, what procedures are covered, how to change plans when moving, how to file an appeal when a service has been denied, how to apply for some of the assistance programs. Quite often PA MEDI counselors are asked to help with troublesome, critical, difficult situations. These might involve issues of lost coverage, inadequate coverage, inability to get coverage. The beneficiary may have tried unsuccessfully to resolve the issue on their own. As a program, PA MEDI has direct contact with the Social Security Administration, the County Assistance Office, and Medicare. Having these contacts along with state and national recognition is critical for the success of PA MEDI work with Medicare beneficiaries. (Quote from client): “I am beyond frustrated. I have been unsuccessful after multiple times trying. At one point it (the Social Security website) locked me out.”

Does PA MEDI have outreach programs for the community?

Group presentations are also available in the community at local libraries, churches, and senior centers. Attendance at these presentations is by reservation only. There are “Medicare 101” and “Medicare 102” programs available virtually or, where public health protocols allow, the meetings will be in person. The schedule and instructions for registration are available at https://www.chesco. org/calendar.aspx?CID=22. You can also call the Help Line for information. “Medicare 101” is a presentation for individuals becoming eligible for Medicare and provides a great opportunity to learn the basics of enrollment and coverage. People who attend a Medicare 101 presentation ask more informed questions at their one-on-one sessions. “Medicare 102” is especially informative for those already enrolled in Medicare. “Medicare 102” presentations include such topics as Medicare-covered preventive services, outpatient therapy, home health services, medical equipment, diabetic supplies, fraud prevention, and more. “Medicare Open Enrollment – Fine Tune Your Medicare” presentations help to make beneficiaries aware of changes that can be made during the Medicare Annual Open Enrollment Period to get the most out of Medicare during the next year. (other comments about the presentations): “You have such a great way of presenting the information which really helps to reduce one’s anxiety over trying to figure out the complex world of Medicare.” “Very thorough.” “I know what to do now.” “Better than expected.”

How can I contact PA MEDI?

The overriding goal for our PA MEDI program is to educate and provide information that gives Medicare beneficiaries the tools to better understand and navigate their medical coverage – ultimately to have best access to their care. Contact for PA MEDI can be by phone on our Help Line (610-344-5004, Option 2) or by email (smilam@chesco.org). Counselors pick up these messages daily and return calls within one business day. The website www.chesco.org/477/PA-MEDI has a collection of articles and newsletters with information on many topics relating to Medicare.