PORT ANGELES — The annual torrent of Medicare Advantage television commercials may be a clue that Medicare open enrollment has arrived.
During the open enrollment period, which began Oct. 15 and ends Dec. 7, Medicare beneficiaries can review their plans and make changes to their coverage.
According to the Centers for Medicare & Medicaid Services, 66 million Americans older than 65 are enrolled in the federal insurance program and more than half are enrolled in Medicaid Advantage plans — commercial insurance that is an alternative to traditional Medicare.
Navigating the complex landscape can be difficult, and the advertising blitz can make the task even more difficult.
Free counseling sessions with Statewide Health Insurance Benefits Advisors (SHIBA) and guidance from providers in Clallam and Jefferson counties can untangle some of the confusion and provide direction for choosing a plan.
Volunteers with SHIBA, a service of the state Office of the Insurance Commissioner, work one-on-one with Medicare beneficiaries to determine their eligibility for health care plans, assess their coverage needs, speak with Medicare on their behalf and lead them through the enrollment process.
The Olympic Area Agency on Aging (O3A) sponsors SHIBA sessions year-round, but it’s the busiest during open enrollment.
Eva Bennett, SHIBA volunteer coordinator and trainer at O3A, said people who attend the first-come, first-served events it holds on the North Olympic Peninsula should arrive before the start time. Entry to a recent session held at the Port Angeles Senior Center was cut off 10 minutes after it opened, Bennett said.
One of the biggest challenges facing Medicare beneficiaries is the volume of choices and the amount of information, much of it coming from insurance companies promoting Medicare Advantage plans.
“Many people are confused by the ads. They get lots of mailers and they get lots of phone calls,” Bennett said. “All that is, is people selling, so they need to be very careful.”
Most people don’t shop for plans. According to a survey by the health research nonprofit KFF — formerly known as the Kaiser Family Foundation — fewer than 70 percent of Medicare beneficiaries compare coverage options during open enrollment.
As difficult as it can be, looking for and finding the right plan can help ensure you receive the right care. It also can save money.
Susie Brandelius, a SHIBA advisor in O3A’s Forks office, said she’s saved clients hundreds of dollars helping them enroll in Medicare’s drug plan.
Clients fill out a form with information about their medications, and Brandelius enters it into the Medicare website to find the lowest out-of-pocket cost. She sends the results to the client, who tells her which plan they want, and Brandelius submits their approval to Medicare.
“They don’t have to do anything,” said Brandelius, who received almost 300 applications this year. “Just wait for their new card in the mail.”
She said the system worked well for her clients, many of whom lacked internet access or found the Medicare website too difficult to use. Others weren’t aware of updates to Medicare drug plans, so they remained on plans that cost them more than they should have been spending.
Medicare plans, health and medical needs, finances and access to providers all can change during the course of a year, and that’s why beneficiaries should review their plans annually, experts say.
Regence Insurance, for example, will no longer offer its three Medicare Advantage plans in 13 counties in Washington state, including Clallam and Jefferson.
“All of a sudden, all of these people don’t have a plan available to them starting Jan. 1,” Bennett said. “They’ll still have original Medicare, but they won’t have anything supplemental to that. So, they need to take a look at their situation and decide what to do.”
Medicare Advantage plans can appear to be attractive alternatives to Medicare because they cover services it doesn’t, like vision and dental care. But Medicare Advantage plans have disadvantages that patients need to be aware of, said Dr. Michael Maxwell, North Olympic Healthcare Networks’ chief executive officer.
“They can provide fairly good coverage,” he said. “But there is pre-authorization for tests and care that are usually denied. That can add weeks to months of waiting until they’re finally approved.”
During that time, medical care can be put on hold until the insurer grants its approval.
Unlike traditional Medicare that is accepted across the country by most doctors and hospitals, Medicare Advantage plans are based on provider networks that can limit access to care, constraining a person’s ability to find local providers if they don’t work with their plan.
With traditional Medicare, Maxwell said, “I can make referrals to whom I want, where I want and when I want.”
Talking to your doctor about your medical and healthcare needs is an important step in making an informed decision about the plan you choose, he said.
Although they don’t assist with enrollment like SHIBA, community resource navigators at NOHN and financial counselors at Olympic Medical Center and Jefferson Healthcare are knowledgeable sources for general information about Medicare and Medicare Advantage plans.
Damon McCutcheon, patient access manager at Jefferson Healthcare, said its financial counseling staff are able to help many people during open enrollment. As certified application counselors, they help people understand their current coverage, explain the insurance process and steer them through the Washington Healthplanfinder to find dental, vision and other insurance on the open market.
There are ways patients can assist the counselors, McCutcheon said.
“Having the questions you want answered at hand, knowing what you’re looking for, knowing where you want to seek care, knowing if you want a plan that has a low premium but higher out-of-pocket costs or vice versa will help us understand what your goals are and better guide you,” he said.
If a person believes they might qualify for low-income assistance, bringing financial information to a visit is particularly helpful as well, McCutcheon said.
“Don’t try to do it all yourself,” McCutcheon said. “Use the resources that are available and have someone walk you through so you make the best choice.”
Health care resources
Statewide Health Insurance Benefits Advisors (SHIBA) provide free, one-on-one open enrollment assistance on a first-come, first-served basis. Bring health plan cards (Medicare, Medicare Advantage, prescription drug plan, etc.); a list of current medications; and the username and password for your Medicare.gov account (if you have one).
Chimacum
Tri-Area Community Center, 10 West Valley Road
From 10 a.m. to 1 p.m. Nov. 26
Port Angeles
Port Angeles Senior Center, 328 E. Seventh St.
1 p.m. Nov. 20 (info session only — no one-on-one assistance)
From 10 a.m. to 1 p.m. Nov. 22
From 10 a.m. to 1 p.m. Dec. 6
Port Townsend
Port Townsend Senior Center, 620 Tyler St.
From Noon to 3 p.m. Nov. 19
From Noon to 3 p.m. Dec. 3
Quilcene
Quilcene Community Center, 294951 U.S. Highway 101
From 10 a.m. to 1 p.m. Nov. 27
Sequim
Shipley Center, 921 E. Hammond St.
From 10 a.m. to 1 p.m. Nov. 19
From 10 a.m. to 1 p.m. Dec. 3
Forks
Contact Susie Brandelius in the O3A office, 481 Fifth Ave., at 360-374-9496.
Contacts
• SHIBA offers virtual sessions during open enrollment every from 5:30 p.m. to 7 p.m. Monday through Friday, except Nov. 26-29. The daily Zoom calls can be accessed at https://wa-oic.zoom.us/j/83335612115. Or you can call 253-205-0468 and enter code 83335612115#
To reach SHIBA directly, call 800-562-6900.
• Jefferson Healthcare financial counselors, 360-385-2271.
• NOHN Community Resource Navigators, 360-452-7891, ext. 2894 or ext. 3011
• Olympic Medical Center financial counselors, 360-417-7111
• The Medicare.gov website has many resources and is fairly easy to navigate. You can compare coverage options, find health and drug plans and order “Medicare & You 2025.” The free booklet is available in a number of languages and in large print. Go to www.medicare.gov/publication-ordering/10050. To speak with a person, call 1-800-MEDICARE (1-800-633-4227).
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Reporter Paula Hunt can be reached by email at paula.hunt@peninsuladailynews.com.
