Earlier this morning I interviewed Julie Woodward on my WVOX radio program about medicare. A forum is being held at the Theodore Young Community Center this coming Wednesday, May 6thbetween 6:15-9 PM. The information below may be helpful to those who want to learn more about medicare. Volunteers are also at the Greenburgh Library form 10 AM to 1 PM on Monday’s to answer questions about medicare benefits and enrollment as well as related senior benefits. This is a free program.
Notes relating to the upcoming “Demystifying Medicare” talks this week in 3 Westchester libraries & TDYCC:
Sat. May 2nd, New Rochelle library, 1-4 pm
Mon. May 4, White Plains library, 6 - 8:45 pm
Wed. May 6 Theodore Young Community Center, Manhattan Ave
in Greenburgh, 6:15 - 9 pm
For pre-registration Demyst Medicare is requested, but walk-ins welcome Please call (914) 231-3236 and leave your name, telephone number and the event you wish to attend.
Helpline for a counseling call-back at firstname.lastname@example.org or (914) 231-3260.
PF: Can you tell us something about WSOS. What the members do?"
JW: WSOS is a community of volunteers, more than 80 strong. They’re passionate about helping seniors get the most from the health insurance benefits they have paid for. Why?
– Medicare is confusing, and the government has not provided enough manpower to help explain it all.
– We also recognize how frustrating it is for people to use web resources like Medicare.gov or Healthcare.gov if they’re not comfortable with computers.
So, we do monthly briefings to various groups across the county (Medicare Minutes). Then when a real question emerges, we have counseling services available at 10 libraries year-round (Senior Benefits Information Centers, or SBICs.) We also do community presentations like Demystifying Medicare, which explain the basics. There are email and telephone Helplines as well. All of these things are free.
PF: "Where do the volunteers get their information. Are they health professionals?
JW: Actually, most of the volunteers are retired, and although some have come from healthcare fields (we have former nursing home administrators and doctors!), we all have spent a fair amount of time steeping ourselves in Medicare and senior healthcare issues.
We get our initial training and monthly updates from the Medicare Rights Center, which is a non-profit organization that works to ensure access to affordable healthcare by counseling, educational programs, and public policy initiatives. It’s not affiliated with any insurance company, or with Medicare itself.
PF: "How did the library system become connected to the Medicare Rights Center?
JW: WSOS is a seminal project in Westchester, and it was originally run by the MRC. The Westchester Library System stepped in to run it because the program is very much in line with some of the library’s goals: to inform, enrich and engage Westchester residents. Now we not only have the ongoing training from the MRC, but we get short briefings from experts at the county and state level to give us some info on other non-Medicare subjects that might help seniors (e.g., EPIC, spend-downs, Ride Connect)
PF: "You mentioned counseling that’s done at the Senior Benefits Information Centers in the libraries. There are 10 of these, I believe?" [Yes] "Which libraries have them?"
JW: On Monday mornings people can go right here to the Greenburgh library. Tuesday mornings there's one at the Hart Library in Shrub Oak, and most Tuesdays also at the Will Library in Yonkers. Wednesday you can go to Mt. Kisco and Tarrytown. The lst two Thursdays
in the month there's an SBIC at Peekskill, the remaining Thursdays it's at Ossining. There's also one in Port Chester on Thursday, and again at Will in Yonkers. Fridays we run an SBIC at the New Rochelle Library. These are listed on our website. westchesterlibraries.org/senior-benefits-information-centers.
NOTE: If you want to go to one of the SBICs for help, please be sure to bring your insurance cards, and also a list of the drugs you're taking, so we can help build you a druglist on Medicare.gov’s PlanFinder.
PF: "Who generally goes for help at the Senior Benefit Information Centers?"
JW: All kinds of people, from all walks of life. People who.....
• Are going to be 65 and need to know how the whole system works - takes 1-1/2 hrs.
• Are struggling with the finances and need to know about cost-saving programs
• Never signed up for Part B when they retired and now face a penalty bec. they didn’t
• Have been under their spouse's plan, who has just passed
• Whose doctors have dropped out of the plan and they need to find other alternatives
• Who all of a sudden have to take a new expensive drug and their plan doesn't cover it.
• Have billing issues
PF: "Perhaps you can give us some examples of the kinds of problems you've just mentioned and how you've been able to help these people."
JW: So many kinds of problems:
(a) Sheer age of Medicare recipients: is this a time of life to worry about the intricacies of a complicate system? 82-yr-old woman, husband passed, but he had done all the paperwork, now she has to do it and doesn’t know if her HMO is the best choice for her needs.
(b) Billing issues:
Why a $180 for a physical? (physicals and wellness visits separate things)
Why a bill from the hospital (had never gotten hospital bill before: social worker had said the skilled nursing facility wouldn’t cost them anything, but there was a bill. We helped them determine whether billing error, “facility fee,” or just wrong advice.
Hospital Admission vs. Observation
(c) Shingles shot: you can cut the costs of these if you ask the right questions
(d) Someone needed details about Oxygen equipment, which is DME (Durable Medical Equipment, Part D). You can get these things from vendors in NYS when you know how to do it and what you need from your doctor.
(e) An elderly man came in with his daughter, his premium having inexplicably changed mid-year. It took an hour just to sort out the basics. We called his plan for, only to find, yes, the premium went up at the start of the year, but his cost-savings program (MSP) changed, and the plan was paying less of the premium than before. They had no idea where to begin with this, but we know from experience where the hidden quirks of the industry lie and just plow through.
(f) How to file an appeal
(g) How it all works. A good thorough explanation one on one takes about an hour and half. But we do these all the time. For free.
PF: "So let’s talk a little about the “basics” program you’re doing, the “Demystifying Medicare” talks you’re giving around the county. Why is there a need for this program -- it’s a long talk, isn’t it? 2 or 3 hours, right?”
JW: Yes, it’s long, but we try to make it fun. We even play games. And I don’t let anyone take notes. That’s too much like work.
(a) HISTORY COMPLICATED: Medicare is so complicated because the law was developed bit by bit, beginning with the Soc. Security Act of 1935. That created Titles 18 and 19 for Medicare and Medicaid. Then:
• therapies and managed care companies (like HMOs) in the 70s
• in the 90s those became Medicare Advantage plans
• Part D started in 2006 (there wasn’t any drug component before that)
• IRMAA surcharges (Income-Related Monthly Adjustments Amounts)
(b) So, apart from the morphing of the Medicare laws, there’s all these parts. And the government side of it, Original Medicare, interfaces with the private insurance companies, drug and medical ones.
(c) Then there’s retiree coverage: not all employers offer it, even if they do, there’s not always enough info from human resources departments or unions. And companies sometimes drop retiree coverage (i.e., GE, IBM, Time Warner. One article said that in 2014-15, 44% of companies plan to stop administering health plans.)
(d) “Coverage gap” / Donut hole: drug plans can place a temporary limit on costs, which causes severe financial difficulties for some people. (Once you and your plan have spent $2,960 (2015), the plan stops paying. People don’t know how that works and how they can get help from heavy drug costs.
(e) Then of course there's confusion over what changes with the ACA (Affordable Care Act); also with terminology (e.g., SHOP plans, Exchanges, Marketplace)
PF: "Who are you trying to reach with the Demystifying programs you’re doing this week?”
JW: We are now trying to reach out to:
• people who are approaching 65 and know nothing about it.
• people planning for their retirement
• people who are not yet old enough for Medicare themselves, but who have been handling their parents' paperwork. Or helping older relatives and friends.
• even legislators who get calls from constituents with Medicare issues and don't know how to answer them have expressed interest
PF: "We’ve just come through the 2014 tax season, and some people were surprised that if they didn’t have “minimal essential healthcare coverage” - MEC - they got a penalty. How does the tax law work with Medicare?”
JW: The easiest answer is that as long as you have Medicare Part A or an Advantage Plan, you’ll be fine, no penalty. Medicaid also. All of these government health programs operate outside the Marketplace. That does not mean that aspects of the Affordable Care Act don’t affect Medicare, they do. But they’re what most people would think of positive additions to a Medicare.
PF: “Can you name some of the ways Medicare has been affected by the ACA?”
JW: Well, there are some good things that people don’t see.
• Recovered billions over the past 5 years as a result of fraud ($19 billion)
• Med. Adv. Plans can’t spend more than 15% of their Medicare payment in admin, or profits, or non-healthcare issues.
• Insures Medicare will last until at least to 2029
• It rewards plans that increase the quality of coverage
But for the more visible benefits:
• Part B premium remained the same for 2015 -- second year in a row
• Continuing to close the donut hole, so that drug costs for some people have been coming down. Closed entirely by the year 2020
• Some free services offered in the new law:
Preventive care (mammos, colonoscopies, Pap tests)
Wellness visit Lab tests Bone density test
Tests for people who are at risk for certain things (HIV, glaucoma; also Hep B shot)
Screenings: depression, alcohol misuse, diabetes, prostate cancer
Some counseling: tobacco use, obesity, cardiovascular therapy
PF: “Can you give us some examples of what people on Medicare should be aware of when they think of the ACA and the Marketplace?”
JW: When I said that under the ACA, insurance plans are rewarded for improvements, this means also that MAPs may reduce their provider or pharmacy networks, or they may increase copays or co-insurance amounts. People have to know that their plans can make such changes and use the Open Enrollment period (Oct. 15 to Dec. 7) to re-evaluate their coverage.
There are many reasons why you don’t want to sign up for a Mkt plan when you have Medicare:
(a) First, it’s illegal for someone to see you a plan if you’re on Medicare.
(b) You can’t get any premium tax credits if you’re eligible for Medicare. So a Mkt plan will be more expensive.
(c) The Mkt company can actually refuse to cover most or all of the costs if you’re Medicare eligible.
Most people get Part A on a 10-year work history, so it’s “premium-free.” If you disenroll from Part A in order to get a Mkt plan -- not advisable! -- you have to pay Medicare back for all the benefits you’ve already received. Also, people without Part A can’t collect Soc. Security retirement, so they have to pay all of that back as well. [If you have to pay a premium for Part A, you might want to consider getting a Mkt plan instead — you can get PTC as long as you’re not in Medicare. You also might want to consider a Mkt plan if you’re under 65 and have ESRD.)
Let’s say you’re approaching age 65 and you have to transition into Medicare from a Mkt plan. First enroll in Part B so your coverage will start the month you’re 65. Also: notify the Mkt company at least 14 days before you want that coverage to end.
There are more and more SHOP plans -- these are plans you’re employer has purchased for the business through the Mkt. Medicare works with SHOP plans the same as regular employer plans: Medicare pays primary or secondary to the employer plan depending on company size, so you have to find out whether the company wants you to have Part B or not. If Medicare pays first, you have to have Part B. Ask human resources. Then tell Soc. Security (800/772-1213) what you found out, and get it all in writing.
Stand-alone dental plans. You can’t buy one of these in NYS without buying a Mkt plan as well, and since you have Medicare, you can’t do that. So you can’t get a stand-alone dental plan in this state.
PF: "Can we get back to the tax law for a moment. You said you volunteer with the AARP tax-aide program, where they prepare returns for seniors and others who need their help free of charge. What kinds of tax issues have come up, or what do people have to know about the make sure they don’t get hit with unexpected costs?”
JW: The tricky part relating to Medicare per se has to do with shifting from the Mkt plan into Medicare. You don’t want to overlap the plans, because you don’t want to pay back any advance tax credit. Keep the Mkt informed of the changes in your life -- and that’s a good rule of thumb in general. Some people really got burned this year because law is so new and they were getting incomplete advice.
PF: “Can you give us an example?”
JW: One family took out money early from their IRA to buy their first home. That’s allowed: first-time buyers don’t get a penalty for that. But when that large sum got counted as “income,” not only did they have to pay a huge amount of tax they weren’t expecting, but they lost their advanced PTC. When that was reconciled, they had to pay back thousands of dollars. They knew enough to ask about a penalty if they took early withdrawal, but no one gave them the right advice about the income tax burden or the advance PTC. We encouraged them to appeal that one.
Another example: Someone lost his job and knew he had to sign up for Medicaid so as not to get a penalty for not having insurance. So he went the normal route and signed up with the Dept of Social Services. Well, they didn’t want to enroll him for 3 months. If he had signed up over the phone with the Mkt, they would have enrolled him immediately and even back-dated it to the beginning of the month! An anomaly in the law. Hopefully it will be fixed -- and that people will get educated on it!
PF: “Will there be changes in the tax law for 2016?”
JW: Yes. Penalties will be much higher for not having Minimal Essential Coverage. By the way: it’s not just a flat fee ($325 for a single person for tax year 2015). It’s the LARGER of the flat fee or 2% of your income above the filing threshold (about $10,150). There’s a cap on that, but that 2% can be much higher than the $325. It’s more for families.
There will be new forms. This year we saw the tax form from the Mkt (1095-A), but next year there will be forms from other plans, like employer plans. Medicare will still be MEC - it will still operate outside the Mkt.
There were lots of exemptions that saved people from penalties this year, like a short gap in coverage. There’s bound to be some changes in those exemptions.
PF: "I understand there are some other programs for seniors being offered by the library. One is “Pull up a Chair” and the other is “Music and Memory” - both at the New Rochelle Library.
JW: Yes. Pull up a Chair is for people 50+. It’s to help them identify services that can help them: health, housing, education, employment, caregiving. It’s on Monday and Tuesday evenings, by appointment. “Music and Memory” is a pilot program to help people reconnect with family members who have dementia or Alzheimers. You can call the coordinator of these, Marissa Richardson, to find out more about them: (924) 231-3275.
Good things are happening in the libraries: from jobs for young teens, to tutoring so you can get a high school equivalency diploma, to learning a language. There are book discussions, or 3D printer classes. It’s a place where ideas are born and nurtured.
PF: "What is the final message you have for people about Medicare and your various programs?”
Talking about Medicare usually makes people's eyes glaze over. With Demystifying Medicare, we do our best to keep this program upbeat and interactive.
It’s not only for people already on Medicare, but for a whole slew of others: those soon to be eligible, people planning their retirement finances, people caring for their parents, etc.
Medicare is complicated -- but without it, many seniors would really be lost. And I don't think many who would ever want to give it up! So understanding the way this behemoth works is the key to breaking through that confusion. It's not so overwhelming when someone can explain to you the "basics":
•Various parts •What kinds of plans are there? how do they work? •How to enroll •Costs (premiums, deductibles, copays, penalties) •How to make changes •How to appeal •Cost-savings programs from feds or state
People who come to these sessions will leave knowing what kinds of choices they're going to have to make to get the coverage they're looking for.
They'll also know there are people year-round who can help them if they need more individual attention. No fee. This is all volunteer.
And as Elena Falcon says (she’s Director of Public Innovation and Engagement at the library, and head of our program) -- Understanding consumer rights is important, as well as the need for consumers to be educated and proactive.