No matter what your Medicare insurance dilemma or catastrophe, help is available from Senior Community Service’s (SCS) APPRISE Program Coordinator, Kim Andrews. She helps seniors and those on disability make informed insurance decisions and, to resolve problems that would send most people over the edge.
     Medicare’s Open Enrollment period is Nov. 15th through Dec. 31st when beneficiaries, can enroll in or change Medicare Advantage plans (HMO, PPO), change to a Medigap Supplement plan, enroll in or change a Part D prescription drug plan, or return to traditional Medicare.
     Andrews cautions beneficiaries to review their plans every year because Part D plans especially, change their premiums and list of covered drugs which could cost you money. Medicare Advantage plans can also change their benefit package, premiums and provider network (Doctors and Hospitals).
     “Before you decide to change your Advantage plan, you need to verify that your Doctor accepts that plan.
One change this year is with Independence Blue Cross, which is canceling three plans that will affect over 50,000 people in a five-county area—the Keystone Complete plan, the Keystone 65 Value plan and the Personal Choice 65 plan. This change will affect over 6,200 consumers in Delaware County alone. Keystone 65 Complete insures Medicare/Medicaid consumers. Aetna has also cancelled their two PPO plans. The cancellations of Aetna and Blue Cross have affected 60,000 Delaware Valley Medicare recipients.
     Andrews loves her job, especially resolving difficult situations, and hearing the relief in someone’s voice on the other end of the phone.
      “A mother called me in tears, slightly hysterical, because her child was on the verge of a seizure,” she relates. “When she went to the drug store for anti-seizure meds, she discovered that the company had cancelled her insurance. The child has asthma and uses an inhaler, is on insulin for diabetes and needs expensive medicines for grand mal seizures. In emergency cases such as this, a pharmacy must give an emergency five-day supply, but at full cost. That would have caused a hardship for the mother.” Andrews was able to refer her to a Pennsylvania state agency for help until she could get insurance coverage the following month.
      Then there was the consumer who applied for the Medicare Savings Program, which pays a Medicare B Premium of $96.40 a month,” explains Andrews. “Unfortunately, because of her income she was enrolled her for full Medicaid, which she didn’t want.”
     As a result the consumer lost her Medigap policy and PACE. Andrews was able work with the Center for Medicare/Medicaid Services (CMS) and have that reversed.
     The APPRISE Program interfaces with many government agencies in solving problems that consumers encounter.
“I am on the phone, helping consumers ninety percent of the time,” Andrews relates. “I love my job! Ninety-nine times out of a hundred I can help them—even if it’s just providing a phone number.”
Andrews and APPRISE volunteers also visit community sites in Delaware County to educate people about Basic Medicare and supplemental converge, Medicare D Prescription Drug Coverage, available benefits and Long Term Care Insurance.
      For assistance call Andrews direct line at 484-494-3769. She and the APPRISE volunteers counseled almost 2,000 consumers last year.
     APPRISE (a State Health Insurance Assistance Program SHIP), is sponsored by SCS.