Help Us Assist People in Getting the Right Medicare Coverage for Them

Help Us Assist People in Getting the Right Medicare Coverage for Them

Medicare’s Open Enrollment Period is only one month away. Once again beneficiaries will be faced with many choices. Whether to stay in Original Medicare or join a Medicare Advantage plan? Whether to switch MA plans, or to return to Original Medicare and buy a supplement plan? The options can be overwhelming and confusing.

We at California Health Advocates work closely with our partners at the Health Insurance Counseling and Advocacy Program (HICAP) to help beneficiaries make informed choices and get the right Medicare coverage for them. (HICAP is California’s SHIP -State Health Insurance Assistance Program- which provides free, individual and unbiased assistance to Medicare beneficiaries and their families on Medicare, Medi-Cal, and a multitude of health insurance related issues.)

It’s a monumental task and unfortunately sometimes beneficiaries get faulty information, misleading marketing materials, or a sales agent who pressures them into joining a plan or type of coverage they don’t want or need. Yet, this is another instance where HICAP and California Health Advocate’s program, the Senior Medicare Patrol can help.

Below is an example of such a case we recently had:

Mrs. M called HICAP in Chico regarding a problem her parents were having with their Medicare coverage. She found out that her father responded to a TV commercial during last year’s Medicare Open Enrollment, and was concerned that he was getting medical bills in the hundreds of dollars for services provided early this year. What the HICAP counselor discovered was that Mrs. M’s parents had been switched from Original Medicare to the new Medicare Advantage plan that was introduced in their county. Her parents were duped into believing that they were getting better coverage for just $26 per month!

So the HICAP counselor called the Senior Medicare Patrol (SMP), one of California Health Advocates projects. One of our SMP staff immediately went into action by calling her contacts at the Centers for Medicare & Medicaid Services (CMS) and the California Department of Managed Care to file a complaint and report the agent’s misrepresentation of the plan. As a result, Mrs. M’s parents were able to restore their coverage with Original Medicare, including their prescription drug plan retroactively to the beginning of January, and thus avoided potentially up to $10,000 in out-of-pocket Medical costs for the year.

This type of collaboration between the HICAP and CHA’s SMP program is continuous and demonstrates one of the many ways we ensure beneficiaries receive the right Medicare coverage for them.

With Medicare’s Open Enrollment on the horizon, through our trainings and collaboration with HICAP and may organizations, CHA has a great opportunity help many beneficiaries navigate their Medicare options and find their best coverage option. Please consider a generous donation to support our work advocating on behalf of California’s 6.2 million Medicare beneficiaries.

Thank you!!

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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