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Medicare information and advice is a phone call away

It’s a whole new world for specialists at the Health Insurance Counseling & Advocacy Program as they help steer seniors through the complex world of Medicare.

HICAP, a nonprofit organization of the Council of Aging-Southern California, each year provides free Medicare plan counseling to hundreds of seniors in Southern California, said Tamiko Perry, Riverside County project manager. But this year there’s no face-to-face contact with clients as in the past — yet another altering of our “normal” lives by the coronavirus pandemic.

People with questions or concerns about their coverage this year will have to confer by telephone, or sometimes email, rather than meet at locations all over the area as in the past, said Dimitri Lara, project manager for San Bernardino County.

HICAP is currently taking appointments for telephone counseling for the Oct. 15-Dec. 7 Medicare enrollment period. It has served Medicare clients since 1983, beginning in Orange County. It opened an Inland Empire office in Rancho Cucamonga in 2012. Los Angeles County is served by a similar program through the Center for Health Care Rights.

Complicating the counseling process this year is the fact some details about the changes and charges for Medicare for 2021 haven’t been released. Actual costs and specifics on some plan offerings are not yet available from the federal Center for Medicare and Medicaid Services (CMS), with some of that information not available until November, said Perry.

However, Medicare recipients already have a significant amount of information available for those considering making changes.

The CMS had mailed to most Medicare clients its “Medicare & You 2021” handbook, which discusses changes in the program as well as comparisons in Southern California for the various health maintenance organization (HMOs) programs. HICAP also has done its own analysis of more than 90 HMOs locally in preparation for its telephone meetings with clients.

And while the government provides significant amounts of information, Medicare recipients sometimes are confused or swayed by the outside advertising they receive from providers of Medicare Advantage plans.

In this medical marketplace, Medicare Advantage programs offer the basic Medicare Plan A and B services but provide expanded coverage that can include some vision, hearing, dental and fitness programs, some of which can increase the cost for seniors. Each company administers seniors’ Medicare coverage under rules set by the federal government.

Medicare Advantage

The CMS said it expects about 42% of Medicare enrollees to be members of a Medicare Advantage plan next year, which is about 44% more than four years ago. The agency estimated on Sept. 24 the average cost for Medicare Advantage plans was expected to drop 11% in 2021.

“We do get a lot of new clients just entering Medicare, but we also get many who have been confused by all the stuff they have received in the mail,” Perry said. She noted that starting in early October, seniors receive many mailed items promoting new or better services from the many Medicare Advantage providers.

These for-profit companies can offer many special enticements — like gym plans and even home meals — in hopes of convincing seniors to join or switch to their plans during the fall enrollment period. The HICAP specialists will provide an unbiased view of the pluses and minuses of each of these advertised services so the senior can make a decision most beneficial to themselves, said Perry.

Wading through the advertising and printed material from Medicare isn’t an impossible task though it can be plenty confusing. Seniors need to do their homework going through the material, and if needed, ask for help. They also need to use a little sales resistance when considering all the advertised benefits they read about.

“They will see an advertisement for some new feature and come to us and we can explain it for them,” said Lara. “But we also see people who are unhappy with their current plan and need help. We also answer questions such as why a senior had received an unexpected bill for a drug or service.

“And there are people who want more flexibility in the services or even a new doctor who would be closer to where they live. We can help them.”

What’s new for 2021

Among Medicare’s changes for 2021 is a new drug plan which will provide diabetics with low-cost insulin, sharply reducing the out-of-pocket costs for those who need it on a regular basis, according to the CMS. The agency said clients will have 1,600 Medicare Advantage or Part D drug plans that will offer insulin for no more than $35 monthly copay, beginning in January.

Additionally, Medicare will allow those with end-stage renal disease (ESRD) for the first time to join a Medicare Advantage Plan.

Medicare will pay for 12 acupuncture visits in 90 days for chronic low back pain.

Perry said Medicare will now pay for medical or health visits by telephone with physicians or other specialists, services that in the past have been allowed when conducted during in-person medical appointments.

These and other changes and updates are available during the counseling sessions by HICAP. Lara said this year when clients make their telephone appointment, they will be asked to provide in advance a list of their prescription drugs, the name of their current plan and name of their pharmacy. HICAP may send clients in advance their HMO comparisons or some additional information which they will have on hand for their phone appointment.

“The goal is to break down the confusion they may feel from the advertising or the material they may have from Medicare,” said Lara. “It will be different but we can still take them through it all, step by step until they feel confident about the right decision they should make.”

This year, for security and health reasons, the volunteers used by HICAP will be unable to perform telephone counseling with clients. Some will still assist with answering regular phone calls to the program, Perry said.

Changes to Medicare plans can be made through Dec. 7 and will take effect on Jan. 1, 2021. Clients in Medicare Advantage Plans may make one change to their plan between Jan. 1 and March 31.

To learn more

Where to schedule a telephone counseling session with HICAP:

  • Inland Empire: 909-256-8369
  • Orange County: 714-560-0424
  • Los Angeles: 800-824-0780
  • Statewide HICAP information: 800-434-0222
  • Medicare information: 800-633-4227 or

Source: Orange County Register

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