By Thomas Goldsmith
North Carolinians who are 65 or older face a Dec. 7 deadline for making sure their health insurance under Medicare is in order for 2021.
Seniors need to learn the pros and cons of both original fee-for-service Medicare and the increasingly popular Medicare Advantage plans, say people who are knowledgeable about the system.
It can pay to examine those Medicare offerings closely, even those who have had a plan in 2020. And it helps to call on advisers who are trained in the many intricacies of the federal health insurance.
The complicated nature of many Medicare plans means a relentlessly busy season for advisers and volunteers who work with the state NC Seniors’ Health Insurance Information Program, or SHIIP. Sometimes their work involves making sure that beneficiaries know that privately run Medicare Advantage plans can have pitfalls, despite offering benefits such as gym memberships or home-delivered meals.
“The Medicare Advantage plans are advertised widely and don’t stress the ‘pay as you go’ — daily rate in hospital, etc. — and the network restrictions in their ads,” Gina Upchurch, founder and executive director of Senior PharmAssist in Durham, said in an email. “They just play up the ‘perks,’ which can be meaningful to some folks!”
Senior PharmAssist, a nonprofit agency, helps older people in Durham secure benefits and deal with other health issues.
Listening to Broadway Joe
About 40 percent of North Carolina Medicare recipients have entrusted their care to a Medicare Advantage plan. Signed into law by President Bill Clinton as Medicare+Choice in 1997, Medicare Advantage coverage is paid for by the Medicare system but overseen by commercial insurance companies.
The restrictions Upchurch referenced mean that people on Medicare Advantage are strongly encouraged to see professionals and health care facilities in the plan’s network, or else pay out-of-network fees.
Insurance brokers who push Medicare Advantage plans correctly state that enrollees can visit any doctor who takes Medicare. What they often don’t say is that those same doctors aren’t required to take Medicare patients, and many don’t.
Melinda Munden, state SHIIP director, noted that celebrity endorsements can influence consumers who are choosing health insurance, as in other areas.
“I’m sure many people have seen the commercials with Joe Namath,” Munden said during a telephone interview. “And that has certainly generated a lot of interest in questions and opportunities for us to educate consumers on the products that are being endorsed.
“People need to make sure that their doctors, their pharmacies, their specialists, their hospital, are always in the network or accept those Medicare Advantage plans because it can look great on paper, but if your doctor doesn’t take it that’s not necessarily the best thing for you.”
Pandemic complicates things
As might be expected, the arrival of the novel coronavirus pandemic became a significant X-factor this year for those charged with helping older North Carolinians make their insurance choices.
“We have called in half staff each day to the office, and volunteer SHIIP counselors come in to help folks and others working from home,” Upchurch wrote.
Senior PharmAssist counselors are working with many clients via Google meeting technology which allows for the display of documents and screens when video is possible.
“If it’s only phone — and there is a major digital divide — we also use Google Meet, so whether on video or phone, a pharmacist at Senior PharmAssist can always join the appointment to look at the medications to make sure there are no obvious med problems and provide a second set of eyes and another brain around counseling options,” Upchurch said.
The first priority at SHIIP, Munden said, is offering the same counseling services they have in years past while ensuring the safety of the agency’s 28 employees and about 1,000 volunteers who work in each of North Carolina’s 100 counties.
“A number of our sites were closed to the public,” she said. “It was a transition to providing counseling through different measures.”
Open enrollment began Oct. 15 this year and concludes on Dec. 7. However, from Jan. 1 until March 31, people on Medicare Advantage can change plans and make other changes in their policies. That’s one of the many changes that the Centers for Medicare and Medicaid Services, the federal supervisory agency, has made to make Medicare Advantage a hot item.
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