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health care reform bill: what can seniors expect?

Story and photo by LIZ QUIRIN
Messenger editor

Older Americans who try to navigate the Medicare maze without help may feel they’re out at sea in a small boat with nothing but ocean and oars. They need to find the SHIP — that’s Senior Health Insurance Program — counselors to understand their needs and decide not only what kind of plans meet their needs but also how to keep up with programs that can change on an annual basis.

If you’ve already signed up for the alphabet soup of Medicare: parts A, B and D, some changes occur every year, and the recently passed and signed Health Care Reform bill adds to the confusion for those who have or will be signing up for Medicare in the coming year.

To find out what’s going on, what folks need to know and how to find help, The Messenger visited people at the Southwestern Illinois Area Agency on Aging in Belleville. Every county in the state is assigned to an office in their area. (Names and telephone numbers can be found at the end of this article.)

Joy Paeth, CEO at the southwestern Illinois office, and Chris Fulton, information and assistance specialist and SHIP counselor, not only know the present Medicare data, they have also been reviewing the changes that will occur as the reform bill rules begin to make changes to Medicare.

“I think of it (the reform bill) more as insurance reform,” Paeth said. “And that’s a good thing.”

One of the first changes will be a $250-rebate to all seniors with Medicare Part D (think drug coverage) who have been caught in the “doughnut hole” where coverage stops and out-of-pocket expenses cansoar to more than $3,000 before coverage kicks back in.

Eventually, that doughnut hole will be completely and permanently closed — by 2020.
One of the real positive changes of the Health Care Reform bill will be Medicare’s ability to negotiate with pharmaceutical companies for lower drug costs because of the size of the pool of people it serves.

In the past, Medicare — the government-run program — was unable to negotiate lower costs, and that’s why Medicare drug charges stayed high while private companies could offer prescriptions at drastically reduced costs.
“There will be regulations on negotiating prices and how generic drugs will enter the marketplace,” Paeth said.

Understanding Medicare Part D is complicated by anyone’s standards, and choosing from among 47 plans for prescription drug coverage in the state of Illinois could overwhelm almost anyone.

“A person needs to look at whether their medications are covered by a particular plan, not whether there is a deductible,” Paeth said.

Sometimes people see a “no deductible” for a plan and think this is the best choice. Maybe it is, but if your medications aren’t covered in that plan, it won’t help you.

Then, as every senior who has Medicare Part D coverage knows, in the fall of the year, the insurance plans publish an annual “notice of change” to their beneficiaries or customers.

A plan that seemed just fine will no longer fit because the company has discontinued covering medicines that you take. It’s time to shop for another plan.

The problem arises when seniors feel safe and secure with their insurance company and don’t read the annual notice of change, both Paeth and Fulton said.

That’s when seniors can call on SHIP counselors, Fulton said. The counselor will meet one-on-one with folks to wade through the plans, ask the right questions and help find one that will best cover the senior.

“You have to be a terribly educated consumer to read and understand the forms,” Paeth said, “so it’s critical to pay attention to the annual notice of change.”

And Medicare won’t pay all the bills. That’s why most seniors opt for a Medicare supplemental insurance plan.
“It’s a personal choice whether to have a Medicare supplement,” Fulton said.

Talking with a SHIP counselor can give people the assurance they need that they have the coverage they want and can afford, Fulton said.

Fifty-six companies offer supplemental insurance in southern Illinois, Paeth said, and each company may have up to 12 plans to offer clients.

“That’s why Chris Fulton is here,” Paeth said, to help people navigate through the companies and plans to see what their needs are and whether one company will fill those needs better than another.

Because the Area Agency on Aging offices are non-profit and are not paid by any insurance companies, their advice and information comes with no strings attached.

“Sometimes, people feel a loyalty to one insurance company,” Fulton said, possibly because that’s the company they have always used. However, that company may not have the best policy for the individual after he or she retires.

Another issue to consider, Paeth and Fulton said: The same policy may not work for both a husband and wife, primarily because of the coverage offered. This is true also for the Medicare Part D for prescription drugs.

People who sign up for a supplemental insurance or possibly a Medicare Advantage Plan to cover costs not covered by Medicare Part A or B, need to make sure they understand all of the requirements.

“If you are a ‘snow bird,’ someone who goes to a warmer climate, coverage, especially for a chronic condition, can be a problem,” Paeth said. “A few Advantage plans are nationwide, but for others you’d be out of luck for routine care.”
Emergencies are generally covered no matter where you are, she added.

Reform of the Medicare Advantage plans will result with the government requiring those insurance companies offering the plans to spend 85 percent of the premiums on health care by 2014, Paeth said.

In the past, the government would make payments to the insurance companies on behalf of its Medicare eligible beneficiaries, and the companies were not spending most of the money to pay for services those beneficiaries were getting.

The reform bill will also add wellness care to Medicare plans.

When health care was being debated, “there were tremendous fears that what people had was no longer going to be there,” Paeth said.

So many voices were fueling those fears, and it seemed that whoever shouted the loudest or most often received the most attention. That did not mean the information was correct or helpful, just that it was “out there.”
“Information was coming from so many sources,” Fulton said, “and people were concerned with catastrophic illness and the ‘what ifs,’ but changes will be incremental.”
So, “seniors can breathe easier,” Paeth said. Just “stay tuned” as the changes are announced and are put into place.
For information in the diocese, please call: Area Agency on Aging of Southwestern Illinois in Belleville at 222-2561; Midland Area Agency on Aging in Centralia at 532-1853; Southeastern Illinois Area Agency on Aging, Inc., in Mt. Carmel at 262-2306; Egyptian Area Agency on Aging, Inc., in Carterville at 985-8311.
To find out the location of a Senior Health Insurance Program counselor in an area near you, please call 800-548-9034.