PORT ANGELES — Open enrollment for the Affordable Care Act marketplace begins today, but for Medicare recipients, the process has been underway for more than two weeks.
For many, it’s a stressful time filled with questions that must be answered before the Dec. 7 deadline.
Should you switch from traditional Medicare to a Medicare Advantage plan, or vice versa? What is Medigap and do you need it? Do you need to change your plan if your prescriptions have changed?
For millions of Americans, the process of enrolling in Medicare can be confusing, time-consuming and high-stakes. The flood of mailers, calls and emails pushing Medicare Advantage plans further complicate decision-making.
Medicare beneficiaries on the North Olympic Peninsula can alleviate some of that stress by turning to trained volunteer counselors with the Statewide Health Insurance Benefits Advisors (SHIBA).
SHIBA counselors provide free in-person, one-on-one confidential assistance, helping people understand their options, determining their eligibility for different programs and guiding them through enrollment.
SHIBA, part of the state Office of the Insurance Commissioner’s Consumer Protection Services, operates year-round, but the program’s biggest surge comes during enrollment.
Olympic Area Agency on Aging (OA3) contracts with the office to recruit and train counselors in Clallam and Jefferson counties. Last year, they assisted about 840 people.
“They’re the front lines, and it takes a lot of effort,” said Tamra Smith of OA3.
“They’re constantly brushing up and educating themselves. They have that working knowledge, and they can find options you didn’t know about.”
In-person sessions with SHIBA counselors are on a first-come, first-served basis. Counselors advise people to arrive early, because, as the enrollment deadline approaches, the lines and wait times get longer.
Counselors typically take 30 to 45 minutes with each person, depending on the complexity of that individual’s situation.
“Some people have very specific questions, while others are so overwhelmed they don’t know where to start,” Smith said. “So I ask them, ‘What brought you here today?’”
The more information a person can provide counselors during their meeting, the better. People are encouraged to bring all of their Medicare and health insurance cards, notices and letters from their current plans, a list of their current prescriptions, dosages and how often they’re taken, and their online Medicare account login name and password.
Knowing the amount you paid in out-of-pocket costs this year also is helpful.
SHIBA volunteers encourage family members and caregivers to accompany clients to the clinics, especially when reviewing coverage options or comparing plans. They also remind enrollees to bring any mailings or plan notices they’ve received.
Counselors emphasize that those who are satisfied with their coverage should still take time to review their plan each fall.
Not enough people do.
According to KFF, a nonprofit organization that provides information on health policy issues, nearly 70 percent of beneficiaries didn’t compare their options during enrollment in 2021.
“Even if you’re happy with your plan, you need to review your coverage every year,” Smith said. “Maybe your health has changed or your plan is no longer accepted by local providers.”
On the North Olympic Peninsula, provider networks are a key consideration.
Traditional Medicare, the federal health insurance program, is accepted by virtually all hospitals and providers. Medicare Advantage plans — also known as Medicare Part C, offered by private insurance companies as an alternative to traditional Medicare — are not.
On the surface, Medicare Advantage plans can seem like a bargain because they often have low monthly premiums. The real cost can come with out-of-pocket expenses.
Forks Community Hospital, Jamestown S’Klallam Family Health Clinic, Jefferson Healthcare and Olympic Medical Center don’t necessarily accept the same Medicare Advantage plans.
SHIBA counselors have worked with people who have unknowingly chosen plans that don’t include providers in their community.
It’s why they caution against making decisions based on a television commercial or a phone call from an insurance agent you don’t know, because you might end up with a plan that is too expensive or doesn’t serve your needs.
Selecting a plan based on what friends or neighbors have isn’t always advisable, either.
“That doesn’t mean it will work for you,” SHIBA volunteer Corey Flohr said. “You probably don’t know that person’s income, medical history and other things that impact the plan and what you’ll pay.”
Flohr has been a SHIBA counselor for 4 1/2 years.
“There are lots of choices that make it harder to decide what you need,” Flohr said. “We’re concerned about what works for you. We don’t sell anything.”
Flohr said the most important step is to take the time to ask questions before signing up for anything.
“Don’t feel pressured to make any decisions,” she said. “If in doubt, talk to us.”
Jefferson Healthcare has partnered with Kristin Manwaring Insurance to offer free educational in-person and virtual sessions about Medicare and Medicare Advantage.
The Medicare 101 events provide basic information, update beneficiaries about changes to the plans and help them understand their options. The agents cannot sell plans at the clinics and attendees aren’t pressured to buy one, Manwaring said, although dedicated sales events are offered separately.
“Our primary mission is to provide people with the information they need in order to make informed decisions,” Manwaring said. “We want people to feel confident about the decision they’ve made. It’s always up to the person to decide what works best for them.”
Another reason to reach out to a SHIBA counselor or a trusted insurance agent is fraud. Beware of people calling and claiming they’re from Medicare and of mail scams which can look a lot like official Medicare mailings.
If you sense something is suspicious, counselors say, give them a call. And never give out personal information.
“Treat your Medicare card like a credit card — never give it out to someone you don’t know,” Smith said.
The guidance from a volunteer counselor can make a world of difference for people like Kristen Olsen of Port Angeles, who attended a SHIBA event at the Port Angeles Senior Center to enroll in Medicare for the first time.
“They were wonderful,” Olsen said of her counselor, Lucille Celestino. “She was so patient and explained everything. It’s very, very confusing — they (Medicare) don’t make it easy. I don’t think I could have done this on my own. I feel a lot better than when I got here.”
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Reporter Paula Hunt can be reached by email at paula.hunt@peninsuladailynews.com.
Open enrollment
Medicare and Medicare Advantage open enrollment is from Oct. 15 through Dec. 7.
To reach a SHIBA advisor or learn about the program, visit www.insurance.wa.gov/shiba or call 800-562-6900.
SHIBA is looking for volunteers who want to help others navigate Medicare. To apply, go to tinyurl.com/y77rakj2.
What to bring
• All of your Medicare and insurance cards (employer plan, dental/vision, etc.)
• Your online Medicare account login name and password
• A list of all of your prescriptions and dosages
• Any Medicare notices or correspondence you’ve received
• Name and location of your pharmacy
Get a free Medicare Open Enrollment Jumpstart Toolkit at insurance.wa.gov/medicaretoolkit.
Walk-in schedule
Clallam County
• Forks, no walk-ins, call 360-374-9496, ext. 2.
• Port Angeles Senior Center, 328 E. Seventh St., from 10 a.m. to 1 p.m. Nov. 14, Nov. 21 and Dec. 5.
• Shipley Center, 921 E. Hammond St., Sequim, from 9 a.m. to noon Nov. 4, Nov. 18 and Dec. 2.
Jefferson County
• Brinnon Community Center, 306144 U.S. Highway 101, from 10 a.m. to noon Nov. 12.
• Port Townsend Community Center, 620 Tyler St., from 1 p.m. to 4 p.m. Nov. 4, Nov. 18 and Dec. 2.
• Quilcene Community Center, 294952 U.S Highway 101, from 10 a.m. to noon Nov. 26.
• Tri-Area Community Center, 10 West Valley Rd., Chimacum, from 10 a.m. to noon Nov. 11 and Nov. 25.
