Southeastern Utah Association of Local Governments Press Release
Open the door for your health care needs and savings on your out of pocket expenses when Medicare Open Enrollment takes place between Oct. 15 and Dec. 7.
The Southeastern Utah Association of Local Governments (SEUALG) offers the State Health Insurance Assistance Program (SHIP) program to help individuals assess their Medicare needs and options.
“Fall open enrollment is the time of year when you can change your Medicare coverage,” said Bill Engle, the SHIP coordinator for the agency. “You can evaluate a stand alone prescription drug plan or enroll in part D. It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care.”
It’s very important to enroll for medicare even if individuals have other insurance that they are currently using. By enrolling when they are eligible, it will help avoid penalties in the future. Medicare is the federal government program that provides health care insurance. If a person is 65 or older, or under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD), open enrollment concerns you.
The State Health Insurance Assistance Program (SHIP) can help individuals understand their Medicare coverage options and navigate any changes. Any change a person makes during Fall Open Enrollment will take effect Jan. 1, 2019. In most cases, Fall Open Enrollment is the only time one can pick a new stand alone insurance or a Part D plan.
Now is the time to review current Medicare health and drug coverage. If one is dissatisfied with their coverage for next year, a ship coordinator can help them evaluate their best options.
Individuals need to determine when their Medicare Initial Enrollment Period (IEP) begins. The IEP is a seven-month period, including the three months before, the month of, and the three months following a person’s 65th birthday. The date when Medicare coverage begins depends on when a person signs up.
Someone who missed their original IEP may be able to enroll in Medicare if they are under 65 and eligible for Medicare because of a disability, the different enrollment period should be automatically enrolled. Fall Open Enrollment is the time of year when one can change their Medicare coverage. Individuals can join a stand-alone prescription drug plan (Part D) plan, switch between Original Medicare with or without a Part D plan.
“It is important to review your plans as they change yearly,” explained Engle. “Even if you are satisfied with your current Medicare coverage, look at other Medicare options in your area that may better suit your individual needs in the upcoming year. For example, check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price.”
There is research that shows that people with Part D could lower their costs by shopping among plans each year. Part D is Medicare’s prescription drug benefit and is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government. It is never provided directly by the government (unlike Original Medicare).There could be another Part D plan in an individuals area that covers the drugs they take with fewer restrictions and/or lower prices.
For those who want to get Part D coverage, they have to choose and enroll in a private Medicare prescription drug plan (PDP). Enrollment is optional (though recommended to avoid incurring future penalties and only allowed during approved enrollment periods). Typically, a person should sign up for Part D when they first become eligible to enroll in Medicare. It is important to understand one’s Medicare coverage choices and to pick that coverage carefully. There are over 25 different private drug plans available to Carbon, Emery and Grand counties.
“Whether you should sign up for a Medicare Part D plan depends on your circumstances,” said Engle. “You may have creditable drug coverage from employer or retiree insurance. If so, you don’t need to enroll in a PDP until you lose this coverage. Also, some people already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and receive additional financial assistance paying for their medicines. There is extra help available for certain financial situation as well. A lot of people won’t ask about the programs as they feel they are a handout. It’s not a handout, however. People have paid into their medicare premiums all of their working years for that very reason.”
Engle said the goal is to be able to reach more people by partnering with other agencies. Partnerships include senior center directors, case managers who provide in-home services, the Emery County Area Agency on Aging and the Meals on Wheels driver in Emery County. The partnerships have assisted the program in being able to conduct interactive presentations and has initiated individual contact with people.
“Last year, we were able to contact individually 857 people and gave 68 outreach presentations,” stated Engle. “The partnerships have not only allowed us to reach more people with our services, but it also enabled us to reach different populations such as those who are home-bound and unable in many cases to get to meetings or activities in the communities.”
Evaluating your options with a SHIP Coordinator can really be beneficial. Last year, Jim, Tom and Jackie (names changed for privacy) had a combined average cost for prescriptions of $3,343 of out-of-pocket expense. The coordinators assisted them in comparing costs of all prescription drug plans in their area.
“We found plans that reduce their average out-of-pocket expense to $870 per year,” said Engle. “This is an average savings of $2,473, a quarter of the price from what they had been paying before. We also explored with them the possibilities of qualifying for extra help or Medicaid to try and save them additional money.”
Another example is George (name changed for privacy) who without a prescription plan would have had to pay $8,650 for the prescription that he is currently taking. The plan that the agency found for him reduced that number to $1,812 during the course of a year.
“These are just a few who we have been able to assist by providing them information and assisting them in finding lower-cost for their medications and enrolling them in the least expensive plan,” explained Engle. “In addition to finding the least expensive plan, we also make sure that the plan covers all of their medications to ensure reduced cost on each prescription.”
People often find themselves having to choose between the basics needs of life and that can often change if they seek some help.
“Many seniors are faced with being able to afford food and medicine. When people are on a fixed income, every dollar saved greatly improves their quality of life. Remember, the open enrollment door closes Dec. 7,” concluded Engle.
A counselor will it be available at each of the senior centers in Grand, Carbon and Emery counties from 11:30 a.m. to 1:30 p.m. each day. Please review the schedule to determine when they will be in your community. Oct. 15 – Moab, Oct. 16 – Green River, Oct. 22 – Emery, Oct. 23 – Price, Oct. 29 – Ferron, Oct. 30 – Price, Nov. 1 – East Carbon, Nov. 5 – Huntington, Nov. 6 – Castle Dale, Nov. 13 – Moab, Nov. 14 – East Carbon, Nov. 20 – Green River, and Nov. 27 – Castle Dale.
Please bring a list of your current prescription drugs and your Medicare card. You may contact Bill Engle, Ombudsman/SHIP Coordinator, at bengle@seualg.utah.gov or (435) 613-0029.